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What is Etiquette-Based Medicine?

By Edited Jul 15, 2015 0 0
Instructing Doctors on Proper Etiquette
Credit: Morguefile photo by Jade

Years ago, when I was a print journalist, I remember interviewing a bright young physician who had made a name for herself. Right now, even though I wrote an article about her, I don't really remember why she was suddenly so famous. But I'll never forget one thing she did.

The doctor and I went to a local restaurant so she could talk. She didn't seem very warm or approachable. Her answers were curt, and she seemed entirely too full of herself.

As we were leaving, she happened to bump into a chair and knock it over. Amazingly, she kept on walking, leaving the chair awkwardly on its side. Another customer could have tripped over it. She apparently expected someone else to pick it up.

Instead of saying "whoops," and rushing to correct a situation that could cause a serious problem, she seemed simply perturbed and mildly annoyed that I wanted to put the chair back where it belonged.

"Let's go," she ordered me, signaling that I'd already taken up enough of her time, and implying that the chair could stay right where it was.

Needless to say, this is not the type of person I would want to be in charge of my health, or the health of my loved one. Yet, she's not the only boorish physician I've met. I've met plenty of others and perhaps you have to. Everyone I know seems to have a rude doctor story.

This is something the profession itself is struggling to deal with, as medical schools across the country have tried to turn out more compassionate graduates.

Can compassion be learned?
Credit: Morguefile photo by mconnors

Good Manners are Calming

Manners should first be taught at a very young age, ideally when someone is still a toddler. This is when they learn that it becomes unacceptable to push someone else, or grab a toy away from another child. They should be learning that tantrums will get them nowhere, and that biting is bad.

Apparently, though, some physicians missed out on these crucial lessons. Some of their naughty behavior is also our fault too. For too long, we've treated doctors as if they were royalty, patiently putting up with any nastiness because of the exalted status of their position.

If a physician was rude, we wrote it off as, "Well, that's just how doctors are." But we continued to visit them, and accept their poor attitude, because that's what we have come to expect.

However, this isn't how customers, especially sick and vulnerable ones, should be handled.

In recent years, this problem of has been thrust into the limelight, following the publication of an opinion piece that was published in the May 8, 2008 edition of the New England Journal of Medicine. This was written by Dr. Michael W. Kahn, MD, following his own experience as a hospital patient.

He was impressed by the manners of his attending physician, born and bred and Europe. Dr. Kahn greatly appreciated this doctor's "Old World" manners.

Although Dr. Kahn noted that he wasn't aware of what the doctor was actually thinking, nonetheless, his demeanor and the way he carried himself was "impeccable."

Dr. Kahn explained this his physician's behavior was "calming," and it cemented his already growing belief that patients are less concerned with "empathy" than with manners.

Plus, as Dr. Kahn pointed out in his reflection, you can't really teach someone how to be empathetic, but you can instruct them on proper behavior.

Teaching Manners in Medical School

Dr. Kahn appears to have coined the term "etiquette-based medicine," which he believes should be stressed more in medical school. At the time, he said he was unaware of any wide-scale effort to instruct students simply to be respectful. Also, he argued, this is the type of behavior that should be expected, much as employees who work with the public in a retail setting are expected to be courteous and attentive.

Also, according to Dr. Kahn, it's possible to implement and to institutionalize better bedside manners in a way that's measurable. Among the examples he cited were requesting permission to enter a patient's hospital room and sitting down by the bedside. It would also be helpful if the physician took a moment to ask the patient how he or she was coping with the hospitalization.

He stressed that this effort shifts the attention away from whether a physician has true compassion toward a patient, and more toward how the doctor behaves.

However, he noted that efforts should also be directed toward building empathy and training doctors to be more "humane."

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