Etiquette-based medicine

May 19, 2008  |  General

A recent issue of the New England Journal of Medicine has a fascinating piece written by Michael Kahn, a psychiatrist who examines his reactions as a patient to the demeanor of his doctor. His term for what he is describing is etiquette-based medicine, and he asks the rhetorical question: “Patients ideally deserve to have a compassionate doctor, but might they be satisfied with one who is simply well-behaved?”

Doctor Kahn makes some excellent points. Medical schools and residency training programs do their best to teach, as much as they can be taught, such things as empathy and compassion for patients. He suggests they also teach good manners — things like properly introducing yourself, shaking hands, and explaining why you are there. Simple rituals like that are important.

I was particularly intrigued by one of the items on his behavior checklist — sitting down. That is a key thing to do for families, especially in the hectic world of the PICU. Standing by the door and eying the clock is not acceptable. I learned the importance of sitting down from my physician-father, who learned it from his, a man who practiced a century ago at a time when physicians often had little to offer except compassion, understanding, and even etiquette.

As Dr. Kahn writes, physicians should at least be as cordial as Nordstrom’s employees.


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