My wife pointed out a CNN article titled It’s not you, doctors are just rude. The writer describes a Johns Hopkins study which finds that medical interns are not doing basic things like introducing themselves to patients or sitting down to talk them eye-to-eye, despite research showing that using these interpersonal skills improve medical outcomes.
As the authors point out in the discussion section of this paper, about two-thirds of patients find a comforting touch from doctors reduces anxiety (and well over half find it healing), yet most young doctors didn’t do that in the John Hopkins study. A randomized trial found that most patients preferred a doctor sit down to talk with them, which was thought to be an indicator of more compassion. But most interns in the Johns Hopkins study didn’t do that either.
The study’s authors speculated that interns don’t engage in these simple behaviors because they don’t see their teachers modeling them. I realize that role modeling is not enough. I need to provide specific feedback and don’t often do it.
On the day I read this article, I made a point of providing feedback, and gave out copies of the article. Will that be enough? Probably not. Because of the Hawthorne effect, trainees may behave in the way they think I want them to behave. Then again, there will be those incredibly busy days on the psychiatry consultation service in which we typically do more flying than sitting.
Now the subjects in this study were medicine interns, and as a psychiatrist, I wonder whether psychiatry interns might pay closer attention to these etiquette-based behaviors. I can tell you I don’t see it very often.
Expectations for doctors are high and yet our systems of care are often ill-designed to accommodate the kinds of humanistic behaviors so important to patients and their families. For example, chairs are not readily available in many patient rooms (residents are actually used to leaving the room to hunt for a chair for me because I make it a point to try to sit down). And in the intensive care units, the beds are often elevated to facilitate nursing cares and certain types of invasive procedures.
The CNN article has a provocative title which probably overgeneralizes resident physicians. But one thing I know: Most residents care deeply about their patients and they tell me that. And I am privileged to witness them demonstrating these feelings by performing many other caring behaviors they display…even if they aren’t sitting down.
This post was written by Dr. James J. Amos, Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award. He blogs at http://thepracticalpsychosomaticist.com
