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Professional Reminders: Interacting with People and Patients

Professional Reminders: Interacting with People and Patients

December 10, 2008 Editorials

In an opinion editorial by Douglas L. Beck, AuD, learn more about the importance of basic professional attributes and simple good manners.

In a recent New York Times article, Boston psychiatrist Michael W. Kahn noted empathy and reflectiveness are important components of medical education. Of course, the same is true in audiology and all health professions. For example, when breaking the news to the parent(s) of a newborn who was just identified via newborn hearing screening that their otherwise perfect child is hearing impaired or deaf (English, Kooper & Bratt, 2004). Dr. Kahn noted that in addition to these basic professional attributes (empathy and reflectiveness) another issue of maximal importance is simply good manners.

Personally, it drives me nuts when I visit professional offices (medical, dental, optometry, audiology, etc.) and witness an office assistant or administrative person “announcing” to the waiting room “Carolyn, Dr. Smith will you see now.” Carolyn Benson (85 years old) rises slowly, using her walker to brace herself as she struggles to her feet, while her grandson (a well-dressed 40-year-old male) assists her as they ambulate slowly toward the exam room. Clearly, it would have been preferable and respectful to call Mrs. Benson, “Mrs. Benson.” Of course, it would've also been nice to have walked over to Mrs. Benson, introduced one's self, and then said, “Hi, Mrs. Benson, we're ready for you now,” while extending a hand to help her rise.

I recall my annual physical from a few years ago. My physician wanted me to have some routine blood work and so I made an appointment, fasted and went to the lab a few days later. They appeared to be running the equivalent of a poorly run blood-based fast food restaurant. After dutifully waiting my turn as some 15 or 20 other people (with an “appointment” at the same time as mine) rose solemnly and entered the chambers, a 30-something person called from the chambers’ cracked doorway “Doug.” I think it echoed. Weird. I rose, walked toward the door and entered the forbidden and mysterious passageway. Without a word, she turned and walked down the hall. Apparently I was supposed to follow. No introduction, no salutation, no human interaction. Just a human “loudspeaker” with an apparently built-in GPS. I followed. I figured we were on our way to the lab - probably. She stood at an open door (2nd one on the right), “Have a seat and roll up your sleeve.” Not wanting to be a pain in the neck, I sat. However, being in an obnoxious mood (remember, I hadn't had breakfast or coffee) I rolled up the sleeve on my short-sleeved polo shirt (as instructed) waiting for her to notice I was wearing short sleeves and there was no need to roll up my sleeve. Levity lost.

She put the chart down, put on gloves and grabbed the alcohol swab and cleaned the skin while saying, “This will be very quick, we just need a little bit this morning.” I could no longer contain myself. I said, “And you are?” And I swear this happened... she said, “I'm the phlebotomist.” To which I said “Hi phlebotomist, I'm the patient.” And, I smiled. I do that sort of thing. She rolled her eyes and then said, “Are you okay with needles and blood samples?” I said, “Yes, I'm fine with it.” Our final verbalization came when she said, “Okay, all done,” and she left the room after instructing me how to urinate into a cup and where to leave the cup. Lovely.

Dr. Kahn referred to Samuel Johnson who wrote, “Man needs more to be reminded than instructed.” I suspect Samuel Johnson is correct most of the time... but my “reminder” went unheeded deep in the bowels of the phlebotomy lab, and it was chilly, and the Queen of Darkness had the needle.

We all know how to be polite, we know it’s important, we know it’s the right thing to do...but sometimes, we just need to be reminded—just like all other professionals and all other people do. I'm absolutely sure (okay, thoroughly certain!) I've personally made many, many, many mistakes while speaking with patients (and others!) too, and "gentle" reminders are useful and appreciated, and so, Dr. Kahn wrote masterfully about “etiquette-based medicine.”

The six primary points he reminds us of included:

  1. Ask permission to enter the room. Simply knock on the door as you open it and say something like “May I join you?" and then wait for a response!
  2. Of course we need to always introduce ourselves to the patient and his or her family (or significant other).
  3. Shaking hands is clearly the right thing to do and it’s always a good thing to sit at the same level as the patient and her family.
  4. Make eye contact and smile—if appropriate.
  5. Dr. Kahn suggests the next step is to explain your role on the health-care team (physicians, nurses, audiologists, optometrists, dentists, techs, PAs, and all others!). As a doctor of audiology, I always introduce myself the same way, “Hi, I'm Dr. Douglas Beck, I’m an audiologist,” and then we go on from there. I always say I'm an audiologist simply to remove all doubt. I want to be clear I am not another person and I want to be clear I'm not a medical doctor. This works quite well and I have never observed any confusion as to who I am or what my role is.
  6. Finally, Dr. Kahn suggests asking the patient how they feel about being in the hospital. Of course, this particular reminder may not directly transfer to the audiologist in a clinical situation. I usually substitute "How are you doing, today?" or something about the weather, or "What brings you into the office today?"

Etiquette-based medicine is built on the fact that people derive comfort and discomfort from specific situations and interactions. Importantly, we can control and drive most of the professional situations and interactions through basic kindness and politeness. Clearly, none of this is rocket science. The more we humanize our professional interactions through appropriate empathy, reflectiveness and politeness, the more we build bridges rather than walls.

Robert Fulghum (1989) wrote a book, titled All I Really Need to Know I Learned in Kindergarten. Here are some of the “take-home” points from that extraordinary book:

  • Share,
  • Play fair,
  • Don't hit,
  • Put things back as they were,
  • Clean your own mess,
  • Don't take things that aren't yours,
  • Say you're sorry when you hurt people,
  • Wash your hands (often),
  • Flush,
  • Live a balanced life,
  • Learn and think
  • Dance and play daily,
  • Take naps,
  • Watch out for traffic, and
  • Hold hands and stick together.

I'm not sure how to apply all of that clinically, but you get the idea.

By Douglas L. Beck, AuD, Board Certified Audiologist, is the Web Content Editor for American Academy of Audiology.

For More Information, References and Recommendations:
English K, Kooper R, and Bratt G. (2004). Informing parents of their child’s hearing loss: “Breaking bad news” guidelines for audiologists. Audiology Today, 16(2), 10-12.

Fulghum R. (1989) All I Really Need To Know I Learned In Kindergarten—Uncommon Thoughts on Common Things. Villard Books. ISBN 0-394-57102-9.

Kahn MW. (2008) The Six Habits of Highly Respected Physicians. December 1, 2008.
http://www.nytimes.com/2008/12/02/health/02etiq.html?_r=1&em

Kahn MW. (2008) Etiquette-Based Medicine. The New England Journal of Medicine. Volume 358:1988-1989 May 8, 2008 Number 19
http://content.nejm.org/cgi/content/full/358/19/1988

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