Comments on: Dr. Manners, I presume?

By: Dr. Vikram

Dr. Vikram — Wed, 05 Aug 2009 20:06:58 +0000

Good article i will rewrite it on my blog as soon as i get time…
bye
dr. vikram

By: me

me — Sun, 18 Jan 2009 14:14:37 +0000

I agree with you on the shrink writing the article isnt a good authority on this.

Rather than asking for permission you might ANNOUNCE yourself as you enter the room (might not work as well in a multi-patient room ) esp if your the doc doing rounds with a herd in tow.

But given that a major cause of death in a hospital is complications from infection esp drug resistant bugs I as your patient would try to avoid the handshaking esp if I cant get up and wash my hands.

By: bongi

bongi — Sat, 27 Dec 2008 06:57:28 +0000

i think i look good with a virtually puffed up chest, john. but thanks for the comment. sweet of you.

By: John

John — Wed, 24 Dec 2008 05:16:13 +0000

It truly is amazing that even within the few posts here the surgeons have to go out of their way to puff their virtual chests up…
Despite the bloggers continuation of the myth that only surgeons and IM residents are overworked, I can see how this list would make physicians uncomfortable.
As a psych resident, I would like to sit and write down the vital elements of the history, but this is only because my feet are aching from seeing the consults the “overworked” surgeons and IM residents call me with at 4 am when Mrs. Jones is waxing and waning.
As in life and as in each patient we see, your manners are dictated by the situation. It’s really that simple. I believe our behavior is examined and blown out of proportion by researchers/reporters whom needs a good article.
And honestly, I wouldn’t want my surgeon to ask me how my day was.. just take out my damn gallbladder and get me out of the MRSA swamp.

By: Laika (Jacqueline)

Laika (Jacqueline) — Wed, 24 Dec 2008 00:01:44 +0000

Mmmm, does this difference in opinion reflect the discrepancy between psychiatrists and doctors, surgeons and other doctors, new world and old world doctors or doctors and patients??

To me it is unfair and unnecessary to put the shrink with his *odd* advice in one corner and the practicing doctor in the other. It is not a match, not one against the other.

All Dr. Khan suggests is that medical education and postgraduate training should place more emphasis on “etiquette-based medicine”. The list as he shows it is not rigid: Citation:
”I would propose a similar approach to tackling the problem of patient satisfaction: that we develop checklists of physician etiquette for the clinical encounter. Here, for instance, is a possible checklist for the first meeting with a hospitalized patient..

The idea of etiquette training was based on complaints of his patients regarding their doctor’s attitude and his own positive experiences with good mannered old world doctors.

Of course in some situations the list is impractical, it is only meant as a guidance for the first approach of hospitalized patients (no urgency), and for some (like me) it is just common sense.

The idea of etiquette-based medicine is not unique, i.e. in our hospital the integration of knowledge, skills and attitude are now central to the new curricula. According to the one who teaches it : “What good are doctors who have great knowledge but behave badly? Or vice versa”?!
(o.k. some surgeons may be pardoned, but only if they are extremely good – they can’t be taught anyway ).

I’ve wrote about this paper a half year ago, see:
http://laikaspoetnik.wordpress.com/2008/05/11/etiquette-based-medicine/
and the related: http://laikaspoetnik.wordpress.com/2008/05/14/appropriate-bedside-manners/

By: enrico

enrico — Mon, 22 Dec 2008 20:41:49 +0000

Hmm…the exchange between Drs. Bongi and Slater just inspired my Christmas post! Thanks guys!

(FWIW, as a patient, I do appreciate a quick knock before entering a *closed* door, just because I may be “indecent” going to or from bathroom/shower/etc. I do expect to potentially lose all modesty to healthcare personnel in the line of duty as per my treatment–this isn’t about forgetting I am in a hospital and not a Hilton–but the yokels playing “looksie” in the hallway aren’t part of that deal.) More later…

By: Jon Slater

Jon Slater — Mon, 22 Dec 2008 20:30:15 +0000

Having had the privilege of being a patient, I think a caring attitude is as important as a caring thought. That is what is meant by bedside manner, and for me, it’s part of the medicine. It’s possible to be efficient, and even to hurt a patient in a therapeutic way without humiliating them. My two cents

By: bongi

bongi — Mon, 22 Dec 2008 19:07:02 +0000

let’s face it. each to his own. a psychiatrist needs to speak and appease. i don’t quite understand a paediatrician knocking before entering. an acute abdomen is usually not checking to see if my name tag is straight. the gunshot wounds don’t usually appreciate a ‘how are you doing? and how do you feel about being in the hospital?’

i’m a surgeon. end up with me and i’m going to hurt you, but it hopefully will be good for you. i’m not there to make you feel better about life. for that go to the shrink that wrote the manners article.

By: Jon Slater

Jon Slater — Mon, 22 Dec 2008 00:00:59 +0000

I’d probably fail on many counts but fwiw…
- I do knock on the door *as I enter*, introducing myself as the patient sees me – this does give a patient time to get modest or to warn me that (s)he needs time to get dressed.
- sometimes I knock on the curtain by saying “knock-knock” – not everyone has a private room
- I *do* sit. If there is no chair, I squat, stand, lean or do whatever I have to to give the impression I have all the time in the world. Paradoxically, I get out faster that way.
- The rest of it – well, my name tag is often missing, I assume that no one is happy about being in hospital, and I try to treat the patient/parent like a human being. Enjoy your posts

By: bongi

bongi — Sun, 21 Dec 2008 20:14:48 +0000

if that psychiatrist graded me i’d fail dismally.

not that this is necessarily my take on it, but i know of a cape town surgeon who told a social worker; “i’ll learn to take a social history when you learn to do an a-p resection.”

By: Strong One

Strong One — Fri, 19 Dec 2008 17:41:25 +0000

I’m agreeing with the message: increasing good patient-physician relationships.
I think we both agree that there are far more good than bad out there. And I guess that’s the take home message. Most physicians do not fall into this category, but the mere fact that it exists and it’s being tolerated should be enough for all of us physician and patients to do a better job at maintaining a positive environment.
I also don’t think you were insensitive.
Great thoughts.

By: Dr. Val

Dr. Val — Thu, 18 Dec 2008 04:05:40 +0000

I liked that you made the connection between the odd advice and the perspective of a psychiatrist who doesn’t work in inpatient medicine. Makes perfect sense. I don’t think you were insensitive.