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Should Doctors Go To Finishing School?

Thanks to KevinMD for pointing out a recent NYT article about “etiquette-based medicine.” The author, a psychiatrist, suggests that physicians should use a check list to ensure courteous behavior and that this sort of thing should be taught in medical school. His suggestions were also published in the New England Journal of Medicine:

• Ask permission to enter the room; wait for an answer.

• Introduce yourself; show your ID badge.

• Shake hands.

• Sit down. Smile if appropriate.

• Explain your role on the health care team.

• Ask how the patient feels about being in the hospital.

If this sort of thing isn’t intuitively obvious to a physician then I’d say the blame should rest with his parents not his medical school. I mean, do we really need to teach doctors to knock on doors and smile on cue? Aren’t those sorts of things taught in pre-school?

It grieves me that some of my peers do not display what some might call “normal behavior” when interacting with patients. But I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.

Now, I don’t excuse disrespectful behavior – we docs must rise above our natural urge to be irritable at times, and remember that our patients are vulnerable and need our help. But for heaven’s sake… let’s drop the smug check lists and finger pointing. We’re all in this together, and it ain’t pretty. 

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3 Responses to “Should Doctors Go To Finishing School?”

  1. enrico says:

    don’t forget a medical school entrance selection process that does allow for a disproportionate amount of individuals who needed this from day one. Sure med student applicants have to show volunteer work and other “soft” things on their apps, but truth be told, if you have the academics, you can fake the “humanity” to get in. Once in, well you’re in, who cares, right?

    It’s true.

  2. Beach Bum says:

    I am of two minds about this topic. On one hand, I agree with you; much of the common human decency and acceptable social behaviour should have been learned in kindergarten and/or at home. And I have seen appalling things from my classmates and colleagues in dealing with patients, either real or fake.

    On the other hand, the patient/doctor encounter can be intimidating to trainees. When I started doing simulated interviews in my Clinical Skills class, I was surprised at how much like an acting performance it was. It felt like I was on stage, the adrenaline started flowing, and I clicked into performance mode. For students who aren’t prepared for this, I suspect that many of them aren’t being rude, they are simply frozen with terror.

    As anyone who has taken music lessons should know, the best way to prepare for the stress of performance is to go through the motions beforehand. When I was preparing students for a performance, I would have them walk through the motions many times: the walk on stage, the getting ready to perform, the signals to the accompanist, the bow afterwards, the walk off stage. Every movement coreographed and (hopefully) imprinted into muscle memory so that when the adrenaline starts flowing (and the brain shuts off) the performer can still do the right and gracious thing.

    I think that checklists coreographing an “ideal” patient encounter could be a very useful tool for helping students learn how to deal with the very real stress involved in seeing patients. But as with any tool, they need to be discarded as students become more comfortable dealing with real patients and develop their own personal style.

  3. Strong One says:

    Hmm.. I wonder if some of the physicians I’ve encountered should go back to pre-school for some much needed training.

    It’s tough out there.

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