When physicians attend a patient, they normally try to instill a personal touch in the encounter through eye-to-eye interaction. However, it is not uncommon for patients to get panicked and ask, ‘What’s wrong, Doc? Is it bad news?’

It is quite a concern that a simple act of respect might be so rare that patients don’t know how to deal with it. A recent study says physicians are being downright rough – a problem they agree can affect health outcomes.

Researchers from Johns Hopkins and University of Maryland Medical Center found that internal medicine residents practiced courteous acts even less frequently, sometimes less than 10% of the time.

Observers measured how often 29 medical residents used five techniques meant to convey respect for patients. Among the findings: the residents only sat down while speaking with patients 9% of the time, and they practiced all the respectful actions in a mere 4% of encounters.

“This reveals some pretty big deficits in the physician-patient relationship,” said Dr. Robert J. Habicht of the University of Maryland School of Medicine, a co-author of the study. “It gives us a chance to focus on finding ways to improve.”

An article on the results appeared in the Journal of Hospital Medicine recently.

Undergraduates from Hopkins and Maryland were hired to follow medical residents at those two institutions and study how they were spending their hours. Researchers also tried to figure out how frequently the residents were showing respect toward patients.

The researchers decided to focus on five physician behaviors used by a Harvard psychiatrist Michael W. Kahn for his study on what he called, “etiquette-based medicine.”

Five ways doctors can convey respect, according to Kahn, include sitting down with the patient, introducing themselves, taking the time to explain his or her role in the treatment plan, touching the patient (offering a handshake or pat on the shoulder) and asking open-ended questions such as, “How are you feeling?”

Researchers noticed sitting down eases the power imbalance that can exist between doctor and patient, introducing oneself and explaining one’s role personalizes the experience, touch communicates a sense of well-being and asking open-ended questions gives patients a chance to be heard.

A comforting touch has been shown to decrease anxiety levels and improve compliance. Random trials have shown that patients believe physicians who sit down are more caring.

Without that bond, the researchers say, many patients will lack the motivation to follow through on what needs to be done to recover and stay healthy.

The observers followed 20 residents from Hopkins and nine from the University of Maryland Medical Center, observing more than 700 physician-patient encounters.

The physicians fared best in asking open-ended questions (70%), worst in sitting down with patients. They touched patients 65% of the time, introduced themselves 40% of the time and explained their role 37% of the time.

The study did not focus on reasons for these findings, but the researchers have some guesses. Urban hospitals are bustling places, which can divide attention. New federal laws requiring doctors to spend more time doing electronic record-keeping are another reason.

For an internist to be technically good, he or she must communicate well. It helps if patients know who they are.


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