How doctors can show respect to patients

“Angelina Gomez,” the medical assistant hollers out to the crowded waiting room. As always, I cringe when I hear this. It sounds so harsh, so cattle-like. I know that the assistant is actually a gentle and caring person, and I understand that he uses a loud voice so that he can be heard over the general din of a large waiting room.

Nevertheless it feels horrible to me, so demeaning, like we’re in the DMV instead of a medical clinic. I want the environment to be more humane, more civilized, and so when I go out to call a patient, I use a much softer voice, with a tone that I hope conveys more respect.

Of course, no one can hear me. Heads turn, ears strain, faces contort as people try to figure out who I am calling. The medical assistant usually gets the right person on the first try. I, on the other hand, end up pacing up and down the waiting room repeating the name. Am I making the environment any better?

There is so much wrong about medicine today. The list is endless and contains so many high-profile items like lack of universal coverage, inequitable distribution of resources, higher reimbursement for procedures than for primary care. But sometimes it’s the tiniest details that seem to affect us the most strongly, and certainly these are the only ones we can possibly control.

I’ve been in other clinics where an overhead announcement is used to call the patients. It certainly offers clarity and volume, and achieves the goal of locating the patients. But it feels even more factory-like to me.

I often try to figure out what a patient will look like, based on their age, sex, and name. There’s a tinge of guilt because I suppose there’s undoubtedly an amount of stereotype involved, but it does allow me to direct my calls to the reasonably appropriate demographic.

There are other small things that can contribute grains of humanity to the doctor-patient encounter, such as how we address patients. Our entire society has shifted toward familiarity and use of first names. Nevertheless, a conscious effort to use patients’ proper names and titles respectful titles is worthwhile. It conveys that the medical profession is here at the patient’s service, not the other way around.

In my particular clinic, much of the care is conducted in Spanish. I am by no means fluent, and my mistakes are legion. (They are often the primary sources of humor in otherwise serious encounters). I’ve tried my best to learn the more formal usages in Spanish–usted vs tu, for example. I get constant ribbing on this from bilingual staff members who insist that I sound archaic, but I persist because I think it contributes a modicum of respect in an environment where patients often feel powerless.

Lastly, how doctors dress and comport themselves has a distinct impact on the environment. Obviously, the most nattily dressed physician who doesn’t know her medicine is worthless, but whenever I see interns dressed overly casually, or in old scrubs, or in clothes better suited to a club, I try to point out the incongruity. I feel a little silly since I am no fashion maven, but it’s important for doctors-in-training to understand how their appearance contributes to the sense of respect their patients glean from them.

I often buttress this conversation with a mention of an older gentleman I took care of in the hospital a few years back. Mr. B–as I’ll call him–was found in his squalid apartment, having fallen in the bathroom, unable to get up. He had the look of someone who was homeless, or nearly so–disheveled, unkempt, emaciated–and I could sense the interns and students unconsciously recoiling from him.

But he was an intelligent man, and we found ourselves in long–often long-winded–conversations. He had many opinions about the medical profession, and I finally asked him what would be the one thing he’d want to teach the upcoming generation of doctors. “Respect,” he said. “Respect for the patients in the little things.” He told me that he felt the doctors were giving him good medical care, but he sensed their mild disparagement toward him. “And half of them don’t even look like doctors,” he added, “running around in ratty clothes and sneakers.”

Up until that point, I hadn’t thought much about how we doctors dressed, but he had a good point. Unfortunately there was a complication in his care-a respiratory arrest in the CT scanner suite thanks to a sedative dose that was too high. He recovered from that, but his case was presented at the monthly departmental conference. After the medical issues regarding cautious sedation of the elderly were reviewed, I stood up and said that this patient had a message for the medical staff. I recounted his observations about how the doctors dressed and treated him, reminding us that patients do notice and do care.

(Mr. B eventually taught us another lesson-about assumptions based on appearance. I saw him several months later, after he had spent time doing intensive physical rehabilitation. He wore a smart blue blazer over a white-button shirt, walking confidently with an elegant silver-tipped cane. His hair was neatly trimmed, and his smile was beaming. The condition we’d seen him in was a temporary one, not a defining one.)

Many of us want to solve the big issues in medicine right now. Unfortunately, we can’t do a whole lot on most of these fronts. But there are a host of small things we can do right now that can improve the environment of medicine. If readers have other suggestions of small do-able things, please post them.

Danielle Ofri is an internal medicine physician and author of What Doctors Feel: How Emotions Affect the Practice of Medicine.

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  • Classof65

    As a patient I prefer to be called Mrs. Blank rather than by my first name — yes, I’m old and old-fashioned! But I have a problem with what to call nurses and nurse-practioners. My eyesight is poor and I can’t read the name-tags unless I would stick my face about a foot from their chest. My hearing is impaired, but if the person would slowly tell me their name I could probably remember it, at least through this visit, but I wouldn’t remember it the next visit, so they’d have to tell me each visit… And I have sciatica, so don’t race to the exam room, I can’t keep up with you! Since my memory is not so great anymore, I’d appreciate having written instructions for anything that I’m supposed to do — rattling off the instructions to me is just a waste of time for you and for me… I’ve tried to tell the staff at my doctor’s office, but it seems I have different staff to deal with each time I visit my doctor — can I ask to have these things put in my chart so the staff will know ahead of time? It embarasses me to have to mention this stuff every time. I’m not retarded or demented, just getting older and slower…

  • Carey

    Here’s one small, doable thing: don’t let patients see you with any drug-company schwag, viz., pens, clipboards, notepads, etc.

    What does all this say to the patient? It says, “my doctor is an unwitting stooge for the pharmaceutical companies that are charging me too much for my medicines.”

    Not all patients think this, but hey, not all patients object to seeing their doctors in jeans and being called “buddy” either. Unless you’re sure you know which of your patients think what, it’s best to err on the side of professional appearance.

  • Anonymous

    Regarding how doctors dress, neatly and cleanly are desirable, of course. But isn’t it known that accessories like ties and jewelry can make carrying microbes from one patient to another easier, so they are best avoided?

  • Patient X

    It would be a good idea for the doctor/nurse to greet the patient by name when entering the exam room. At the end of one of my appointments when my doctor handed me a prescription, I noticed he had written another patient’s name on it. It turned out he had brought in the wrong chart.

  • concerned, educated patient

    My pet peeve is doctors and staff failing to call me by my preferred name. My family has always called me by my middle name (a common practice in the South). I have never used my first name except in legal paperwork (health insurance forms fall into that category).

    I ask each medical office I engage with to call me by my middle name. They diligently circle or otherwise mark the chart, but that rarely works. Subsequently in the visit and at later visits, they usually revert to my first name. I sometimes miss the cattle call in the waiting room thinking they are calling someone else. This also poses a problem when someone does not use my preferred name in the surgical recovery room when I’m drugged or in the middle of the night in the hospital after surgery or during a sleep study … all of which has happened to me on several occasions.

    Sometimes, after repeated requests and reminders to use my middle name, I start insisting that they call me by my title and last name (Dr. … I hold a PhD and I carefully clarify that point). That usually gets their attention and they remember that … or they remember to use my middle name (another subtle form of lack of respect after I’ve formally requested use of my title and last name).

    My discipline is information systems, so I know computer systems could present a preferred name in screens and charts while retaining in the database the first name which is needed for insurance purposes. The programming code is not difficult … it’s a lack of concern on the part of systems designers and their failure to understand the psychological impact on the doctor/patient relationship .

    When doctors and staff persistently refuse my request, I feel that they see me only as a chart or a diagnosis … not as a real, live person. I feel that they aren’t really listening to me or focusing their attention on my situation. I feel like a number being pushed through to increase revenue. That, in turn, makes me a uneasy …even afraid that I’m not getting a proper diagnosis (because that’s happened in the past). It undermines my trust and sometimes my willingness to comply with that doctor’s recommendations.

    So, I think showing respect to the patient is critical in achieving an good outcome as well as to retaining that customer and building a practice.

  • Anonymous

    >>As a patient I prefer to be called Mrs. Blank rather than by my first name — yes, I’m old and old-fashioned!>>

    I’m not that old, but I guess I’m also old-fashioned and find it extremely RUDE to be called by my first name. I’m not sure which is more offensive: to be called by my first name by a 20-something year-old MA or nurse, or to be called by my first name by a physician who then introduces himself as Dr. _____.

    Unless we know one another well, I address my patients as Mr. or Ms. (or Mrs., if appropriate). And I generally respond to any Dr. who introduces himself by his title while using my first name by saying “Hello, Bill. I’m Dr. _____”.

    What a rude profession we’ve become.

  • Patient

    It’s not really that complicated if you want to identify someone by face. Just put a picture in their chart. My children’s pediatrician takes a picture with a digital camera and adds it to their chart.

  • The happy hospitalist

    What a hilarious post. Everyone’s unhappy about nothing that matters. Don’t sweat the small stuff. If you are unhappy with the little stuff, you aren’t going to be happy with the stuff that matters. I understand very clearly that you can’t please everyone all the time. Let the perpetually unhappy people find what works for them. As a doctor, if your clinic is busy, you’re doing everything right

  • Nuclear Fire

    @Anon 1054: Introducing yourself as Dr. ___ is not about the honorific but about the job description, especially in an age where medical students, PAs, ARNPs, dietitians, nurse managers etc. wear the white coats and most doctors no longer do. I do agree that calling people by their first name is quite strange to me and even though my patients call me by my first name (with permission and without any negative thoughts about it on my part) I still feel awkward using anything but polite honorifics with them.

    @Anon 233: I think you hit two great points. Neat and clean is what is important. I’d also add that I’ve called a few older staff physicians for criticizing younger colleagues for “informal” dress when that dress was new, clean and fashionable whereas their sports coat was ratty, threadbare ill-fitting and long out of fashion. Glass houses and all that. Second, the long sleeves and ties etc. are concerning to me for infection. I roll the sleeves on my dress shirt to above my elbows, don’t wear ties or anything below the elbows and wash my hands before each exam. It’s good medicine and shows clear respect.

    Finally, to all who think they are not treated well, why do you keep going to the same place? My mother hated how at Sam’s Club they all call you by your first name. She thought it was very disrespectful. She complained many times but was told it was policy. I finally told her either stop going there or don’t complain to me about it anymore. Thankfully, she wrote them a final complaint letter and enclosed her cut up membership card. I have nothing against Sam’s but if a business isn’t suiting your needs, go elsewhere. Support good physicians who are willing to treat you with respect and make all sorts of good choices. On the other hand, if you prefer to go to the discount, cut-rate price cattle-market, what do you expect? You aren’t going to get Kobe beef at McDonald’s.

    I have patients who travel hundreds of miles to see me and and some drive over two states. I think that’s a little extreme but when I ask them why it’s mostly about piece of mind. And I’m not talking about a concierge service. These are low middle class or poor patients on fixed income. If they can do it, so can a PhD.

  • Classof65

    If I’m not mistaken, the title of this piece has to do with customer service and what we believe would improve it, so the “happy hospitalist” and “nuclear fire” are out of line to belittle our remarks.

    But they are correct in their attitude that if we’re unhappy with the service we should take our business elsewhere. And I have. I doubt that my absence from the offending clinic will be noticed or have much impact — they are the only medical office within 40 miles — but I feel better about “voting with my feet”, knowing that I am no longer supporting a “service” that is demeaning to its patients.

  • Happy Hospitalist

    If you lived life always worried about the way things should have been, you’ll end life wondering what life could have been.

  • Ralph

    We often ask how the patient wants to be called and write it on a white board in the room. It is important to show respect to your patients. It goes both ways ,though. Patients should show respect to the physician as well. Showing up for the appointments on time and being neatly dressed is part of it…

  • Michael Leiter

    Great post.
    People have such a refined sensitivity to the subtle indicators of respect and consideration from others. In our research with health care providers, we find that small improvements in their day-to-day communications among themselves can have far-reaching benefits for their engagement with work.

    So, maintaining a refined sensitivity is a strong discipline, well work the effort.

    All the best,

  • Steve Butler

    The one concern I would caution about calling patients/clients out by name is privacy. I am attorney, but also have to greet clients in a waiting room. I call clients by first name because I feel that it is less likely that other individuals in the waiting room will be able to easily identify the person that I am assisting. (I also explain this to clients when they are offended that I am now more formal with them on introductions.)

    Whenever a medical professional requires personal information, I would suggest that the person be taken to a private area. I am always appalled when I hear medical conditions being discussed loudly in a waiting area. It is also important that medical establishments stop using sign-in sheets. I don’t want every other patient that visits that day to know that I was also in the office.

    I think that this is a very good post, and much of the information is applicable to any professionals that deal with clients on a daily basis. Thank you for sharing your experiences.

  • JenJen

    Respect is a lot more than how you dress or whether you call me Jenny or Miz ___. It’s also about not wasting our time and paying attention to what you’re doing. Constant delays in getting seen, then waiting 30 minutes undressed in a cold exam room with nobody ever checking in or letting you know how much longer it will be. Return trips for lab procedures because the office didn’t bother sending in for insurance approval so you get turned away and have to take more time off work to go back and try again. EVERY time I go for a test, I hear at least one person turned away because of this – “oh, Mrs whozit, I see the test has been ordered, but they didn’t send it in for approval” and have had that happen myself more than once. I recently wasted hours trying to get a prescription that turned out to be both (a) completely wrong and for a disease I don’t have and (b) pulled off the market a year ago. (Dodged a bullet there, actually. I’d be really sick if I had gotten on this particular drug) And I go to a place that uses all the latest EHR/order entry doodads. I understand that managing the schedule and attention to detail can be in conflict, but honestly, that’s what would feel like respect to me, moreso than whether the doctor is wearing dress pants.

  • ED

    The one thing for me – respecting informed consent with cancer screening. No doctor respects a woman’s right to choose which means it’s difficult to get health care if you have made an informed decision not to screen or wish to follow a reduced schedule to protect yourself from harmful over-treatment.
    Also, doctor’s who use their power to hold birth control pills to force women into preventative checks that have nothing to do with the initiation and safe use of the Pill are unethical and I suspect, breaking the law.
    I have finally found a Dr and signed all her disclaimers, but it’s still an uneasy relationship – even though she acknowledges my risk of this cancer is close to zero and the risks of a false positive and over-treatment are high, Dr’s are programmed to put ticks in boxes, especially for women’s health.
    Men are entitled to risk information and make informed decisions, women are treated like children – ordered, lectured, kept ignorant, misled and treated like targets.
    An ethical Dr who respected my right to choose preventative health checks and was honest (rather than engage in scare-mongering) is my ideal Dr.

  • Sarah

    My last primary care physician treated me like an intelligent person, up until one visit when I informed him of a recent hospitalization in a psychiatric ward. There was an almost palpable shift in his treatment of me, and he no longer took any of my questions or issues seriously.

    I had bowel problems severe enough that I thought I would have to quit my job… But irritable bowel syndrome is to be expected in hysterical young women, right? (I was incontinent of large amounts of mucus from my rectum, which I don’t think is a common symptom of IBS.) I had a question about a medication he had prescribed (mefloquine), because the label warned that patients with a history of psychiatric illness should not take this medication, and I had been hospitalized that year, and the year before, and was on medication; his response was to ask my psychiatrist. (She was like, “I’m a psychiatrist; I don’t know anything about antimalarials!”)

    This is not the only doctor I have seen who seems to have decided that crazy patients are not worth listening to… and I acknowledge that I may well be a more-difficult-than-average patient. In which case, I have to commend the doctors who do make the effort to treat me like a human being.

    If i sense a doctor doesn’t respect me as a person, then i leave their practice. But i remain concerned for other patients who don’t have that option, or who don’t have the self-confidence to admit that they are being condescended to. I have thought about writing to this doctor, but why would he listen to me? I’m just a crazy person.

    I have heard enough stories of women being treated condescendingly in childbirth that I am afraid of what might happen to me when that time comes, when I am in pain and unable to advocate for myself.

    Doctors, please don’t treat your patients like crazy people. Or they might end up becoming crazy people… around doctors! Thank you for reading.

  • SunnyD

    My internist often wears jeans but in the short time he has he focuses totally on me and doesn’t take other calls. I could not respect him more. When I am seen by an orthopedist I often have to wear shorts. Frankly I find it less intimidating when the physician is wearing a simple polo shirt rather than a suit.

    The physicians I see are often the same age as me. They don’t know what to call me and I don’t know what to call them. We end up saying “you” a lot. I didn’t know until reading this website that physicians don’t like to be called “doc.” The only physicians that I would consider giving that title are the ones I not only greatly respect but really appreciate and like.

    How about spending the very short time you have focused totally on the patient and their needs rather than routinely taking calls and responding to staff interruptions in the middle of an appointment?

    All patients understand that from time to time there will be emergencies so they will have to wait. They also understand that from time to time someone will need longer than planned…and someday they may be that person. However, when a physician consistently keeps patients waiting a long time it indicates to me that they do not have any respect for their patients’ time.

    As Baby Boomers become heavier users of health care services I believe that a huge shift has to occur in the way that patients are treated. They are quite capable of understanding a lot, have quite a bit of technical information readily available to them and may need more detailed information about their condition in order to feel comfortable with the treatment plan. (My surgeon was stunned that not only had I watched the operation live on the internet but had also performed it in animation and read quite a few PubMed articles about it. Fortunately he was willing and able to communicate with me at the higher level I needed. My research allowed us to spend the limited time discussing the benefits of the surgery rather than getting a simple explanation of how it is done.)

    Baby Boomers in general do not have the same awe of authority figures that characterizes many in the WWII generation. Respect has to be earned.

    Finally, what is it with those 10 year old magazines? One of the first things that I look for in a group is whether they have some decent reading material. I am spending several hundred dollars for a few minutes of your time and if you keep me waiting beyond my appointment time the least you can do is show respect for me by having some decent reading materials available.

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