Introducing yourself to patients is a patient safety issue

One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle communication and innovation.

Kate Granger, a physician in the United Kingdom who is living with terminal cancer, has tapped into that sort of enthusiasm in a big way. Last summer, reflecting on a recent hospital admission, Granger remarked in her insightful blog that some members of her care team never introduced themselves when approaching her. She wrote:

As a health care professional you know so much about your patient. You know their name, their personal details, their health conditions, who they live with and much more. What do we as patients know about our health care professionals? The answer is often absolutely nothing, sometimes it seems not even their names. The balance of power is very one-sided in favour of the health care professional.

She asked that health care professionals make a pledge to introduce themselves to every patient that they meet, and share the challenge with others across the National Health Service. Thus was born a movement that went viral, aided by the Twitter hashtag #hellomynameis. More than five months since her post, there is a steady stream of tweets every day. Some clinicians wear lanyards with the hashtag, a show of support and a reminder to introduce themselves. Recently, NHS Employers released a video celebrating the #hellomynameis campaign.

More than anything, introducing yourself to patients is an issue of providing compassionate care. But it is also a patient safety issue. We know that faulty communication so often lies at the root of medical errors. How many adverse events might be prevented if all clinicians introduced themselves, making them more inviting to questions and concerns?

As Granger points out in her blog post, sometimes we need to do the simple things well, like introducing ourselves, so that the more complex aspects of providing care “will follow more easily and naturally.”

The #hellomynameis campaign is most firmly rooted in the United Kingdom, but it’s a concept that should be adopted by anyone, anywhere who has direct patient contact. Hopefully, it’s not too much to ask caregivers to keep a simple mental checklist of everything they do when approaching a patient: sit down near the patient, introduce yourself by name, listen to the patient and learn from them.

If we join this movement that puts patients at the center of our work, we would see the world differently. If we put patients first, we would have open visiting hours. We would round inside of patients’ rooms rather than in the hallways. We would conduct nursing shift change with the patient and loved ones present rather than without them.

Several years ago at Johns Hopkins, we embraced a similar concept on our surgery teams. Before the start of a case, the entire care team — surgeon, anesthesiologist, nurses and others — introduce themselves by name, as a prelude to going over the details of the operation. They talk about what might go wrong, so they can preemptively deal with those issues before incision. Across health care, we talk about the importance of treating patients and family members as part of the care team.  We can’t honestly profess to be doing that unless they know our names.

Peter Pronovost is an anesthesiologist and director, Armstrong Institute for Patient Safety and Quality.  He blogs at Points from Pronovost.

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  • NewMexicoRam

    Rather, isn’t it just common courtesy?

    • Dr. Drake Ramoray

      Everything is a patient safety issue or medical error. It’s easier to demonize doctors that way.

      • Lisa

        I think introducing yourself to a patient, as you described in your post to EmilyAnon, is both polite and a recognizes patient safety issues.

        • Dr. Drake Ramoray

          That would appear to be the case. Never really thought about it that way. Learn something new everyday.

    • John C. Key MD

      Yes, it is common courtesy, and the lack of introduction is just another byproduct of our general cultural and civility decline. Fifty years ago in elementary school learning to introduce oneself and how to introduce others was an important part of learning–I can remember it being addressed in several classes and even in textbooks. I doubt it is even addressed any more. Likewise the decline in formality and the rush to familiarity has its consequences. I have noticed that my Gen-X children often do not know the surnames of their newer friends, which I find astonishing. I am amazed that any healthcare professional would not automatically introduce himself to a patient or family.

  • Patient Kit

    I had surgery at 7am on a Tuesday, stayed in the hospital one night and went home the next day around 4pm. I still remember the names of all of my nurses. Mona was my nurse in recovery. And upstairs, Al was my day nurse and Casey was my night nurse. I was pretty drugged up and it was all pretty surreal since I was still processing my ovarian cancer diagnosis. But I’m sure of my nurses’ names.

  • EmilyAnon

    I’ve also read that from a safety standpoint the doctor should mention the patient’s name when greeting each other, just in case they’ve brought in the wrong chart. It happened to me once, but was only caught because I happened to notice another patient’s name on the chart cover.

    • Dr. Drake Ramoray

      Interesting, I always make it a point to ask “Mr Jones?” Followed by ” Hi I’m doctor so and so and they asked me to come see you about X”. I never saw it as a patient safety issue, just the right way to start a patient encounter.

      • SarahJ89

        It is just common courtesy, Dr. Drake. But I worked in a hospital in which several patients nearly died from treatments wrongly applied because blood was taken from the wrong patient or an MRI was done on the wrong patient. I simply cannot imagine not introducing oneself (“Mrs. Jones? I’m Susie Sunshine.”) before doing something as intimate as drawing blood. My common courtesy wouldn’t allow it. But I know now it’s a matter of safety also.

        That MRI patient? He was in his mid-thirties, but had the heart of an 85-year old man. Literally, since they’d done the MRI on the wrong patient, an elderly man. In those days we had to transport patients to another hospital 30 miles away for an MRI, which means the sending hospital, transport crew and receiving hospital ALL failed to identify themselves and the patient. Nor did the sending hospital notice the test ordered on the original patient was never done. (And they wonder why I don’t trust hospitals.)

        • Dr. Drake Ramoray

          Thanks for the input. This thread has opened my eyes. I avoid the hospital both as a physician and as a patient. Bad things happen there.

    • Anne-Marie

      I had something similar happen to me. The patient and I had the same first and last name and, get this, our dates of birth were almost identical – same month, same year, just a few days apart.

      Apparently she wasn’t even in the hospital at the time, but her chart was the one that mistakenly got pulled. (This was back in the paper era.) No one realized it until someone made an offhand comment about something they saw in the medical history and I recognized right away that it didn’t match up with my own history at all.

      So, yeah… it’s just common courtesy to introduce yourself but it can also be very important for patient safety. Consider the risk if you proceed under the assumption that the patient is someone else.

      • EmilyAnon

        “Consider the risk if you proceed under the assumption that the patient is someone else.”

        Indeed. The doctor in my story was a substitute for my medical oncologist. This was a routine pre-chemo appointment to determine my fitness for treatment that day. What if the decision was based on someone elses lab counts. Or worse, prescribed chemo for another type of cancer.
        Although I’m sure if it had ever gotten that far, the infusion nurses would have caught it because of stringent check-lists. But still, it’s a scary scenario.

  • SarahJ89

    I used to work for the state welfare dept in a very rural, Deliverance-type area. I loved it there, loved the people. But there was also a couple of truly dangerous areas with people living in caves, old school buses, etc. I always mumbled when I introduced myself because I really didn’t want anyone knowing my name. We were not allowed to have unlisted phones at that time. (Clients called us at home all the time because “I didn’t want to bother you at work. I know you’re busy.”)

    Anyway, the male welfare workers were forbidden, for “safety” reasons, to transport female clients. We females, on the other hand, were expected to travel all over God’s creation in remote areas with large people, some of whom were not well put together. Turns out the “safety” the agency was worried about was its own. They really didn’t care what happened to their workers, but God forbid a female client’s accusation reflect badly on the agency. One of my clients did pull a knife on me.

    Personally, I’ve met enough bad apples to never want my last name on a badge. 99% of the people are fine, interesting, wonderfully so. But once in a while… not worth the risk.

  • Sue Hawes

    Introductions are ALWAYS in order especially in a hospital facility. With the myriad of people coming in and out, entering a room should mean that not only does the person identify themselves but what they have entered the room for.

    That being said, if, in the hospital or similar agency, a doc appears in a patient’s room for some sort of consult or procedure it is imperative that they also tell the person that they accept their medical insurance!!!! Not doing so may leave many unsuspecting patients with huge bills that they never knew they were liable for.

    That is more than courtesy and safety. It is a MUST.