Healthcare News & Insights

Do your interns need etiquette-based communication lessons?

Research has shown physicians with a courteous bedside manner not only have better patient satisfaction scores, but they help improve their patients’ medical recovery. So now that hospital pay is being tied closely to both, you would think doctors-in training would be taught to take the time to introduce themselves to and make nice with patients. But that’s not the case.


Researchers from Johns Hopkins recently found that our medical interns, who’ve received their medical degree and are training in a specialty, lack basic communications skills, like introducing themselves to patients and looking them in the eye when having a conversation. These etiquette-based communications skills have taken a back seat in interns’ training for years.

According to the study, medical interns only spend about 12% of their time interacting with patients — doesn’t seem like a lot of time in the grand scheme of things.

“Basic things make a difference in patient outcomes, and they’re not being done to the extent they should be,” said study leader Dr. Leonard Feldman, an assistant professor of medicine at the Johns Hopkins University School of Medicine and one of the associate program directors of the internal medicine residency program at The Johns Hopkins Hospital, in a report about the study. “These are things that matter to patients and are relatively easy to do.”

5 key strategies

The study watched 29 physicians in their first year out of medical school at The Johns Hopkins Hospital and the University of Maryland Medical Center. Over three weeks, 732 inpatient encounters were observed during 118 intern work shifts. During the observations, the interns were watched to see if they used etiquette-based communication, which consists of five key strategies:

  • introducing themselves
  • explaining their role in the patient’s care
  • touching the patient
  • asking open-ended questions, and
  • sitting with the patient.

The results, which were published online in the Journal of Hospital Medicine, found interns touched their patients — physical exam, handshake, caring touch — 65% of the time, and asked open-ended questions 75% of the time. But when you think about it, these numbers aren’t that good since it’s hard to examine patients without touching them and it’s hard to find out how a patient is doing without asking them questions.

However, they fell very short when it came to:

  • introducing themselves, which  only occurred 40% of the time
  • explaining their role, which only happened 37% of the time,
  • and sitting down during a patient visit, which took place 9% of the time.

But the real shocker is that interns performed all five of the key strategies in only 4% of all the patient encounters.

“Many times when I sit down,” noted Dr. Feldman, “patients say, ‘Oh my God, is something wrong?’ because I actually bothered to take a seat. People should expect their physicians to sit down with them, to introduce themselves. They shouldn’t be taken aback when they actually do. It’s part of being a doctor.”

Altered perception

So why don’t interns use these basic social communication skills?

One reason could be because they don’t see the senior people who are training them use these communications protocols. Previous studies have shown that to be true.

Dr. Feldman says that when he brings interns-in-training into patient rooms on rounds, he has everyone introduce themselves. While the patient probably won’t remember their names, he feels it’s important because it creates a better relationship, not to mention the fact that he’s modeling appropriate behavior that could lead to a better hospital experience for patients.

Another reason for not employing all five strategies is that people often have an altered perception of themselves — and that’s not just doctors.

In a follow-up study, the Johns Hopkins researchers surveyed nine of the 10 Johns Hopkins interns, to see how often they think they used all five communication strategies. Here’s what they found:

  • The interns thought they introduced themselves to their patients and explained their role about 80% of the time, and
  • They also thought they sat down with patients 58% of the time.

A very altered perception of what the reality truly was.

“Our perception of ourselves is off a lot of the time and that’s why it is so important to have data,” stated co-author Dr. Lauren Block, a former general internal medicine fellow at Johns Hopkins.

Simple adjustments

Thankfully, hospitals don’t have to revamp their entire training program to give patients a better hospital stay experience. According to the study, it only requires a few simple adjustments to make some positive improvements, such as:

  • placing chairs in patient rooms for physicians to sit in
  • putting photos of the care team up in patient rooms (research has shown that only 10% of patients can name a doctor who cared for them in the hospital), and
  • adding etiquette-based communication lessons to physicians’ curriculum.

“The hospital is a dizzying place,” said Dr. Feldman. “By introducing ourselves, we can go a long way toward making the entire hospital experience a little less daunting.”


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