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Patients complain that doctors talk too much about themselves

First impressions make a difference in how well physicians and patients communicate, researchers said.

By — Posted July 23, 2007

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The next time you meet a new patient, shake his or her hand -- but don't ramble about your summer vacation.

Patients want a welcome handshake and a greeting by name the first time they see a doctor, a new study found. It's an introduction that starts to build rapport and makes visitors comfortable.

What patients don't want in the first encounter are doctors who talk about themselves and waste the patients' time, another study shows.

"The introductory phase sets the stage for what comes after that," said internist Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, a medical advocacy service for patients. "Patients respond to cues from their doctors. If the doctor says, 'Hello, it's nice to see you,' that sets a very different tone than a doctor rushing into a room with, 'What's going on?' "

A study in the June 11 Archives of Internal Medicine examined patient expectations of greetings in first-time visits with doctors. A national phone survey of 415 patients from 2004 to 2005 found that 78% of patients want doctors to shake hands, while 18% do not want a handshake.

Doctors did fairly well on that front, based on the study's analysis of 123 videotaped new patient visits to 19 primary care offices in Chicago and Burlington, Vt. Patients and doctors shook hands 83% of the time.

The patient survey also found that 50% of them want to be greeted by first name, 17% by last name and 24% by both. The tapes showed that doctors called the patient by first name 14% of the time, by surname 33%.

More than half of patients interviewed said they want doctors to introduce themselves by full name, while 33% said a greeting by last name is fine. The videos revealed that doctors provided their full name in 59% of the cases and by last name 30%.

The tapes showed that in 39% of the visits, the patient's name was never mentioned. In 11%, the physician never gave his or her name.

The study's researchers encourage physicians to shake hands with patients but to be aware of nonverbal cues that patients may not want that kind of greeting. They suggest that doctors use patients' first and last names initially and introduce themselves by full name.

"The reasons greetings are important is they can have an effect on that encounter and on the doctor-patient relationship as it goes forward. First impressions last," said lead author Gregory Makoul, PhD, director of the Center for Communication and Medicine at Northwestern University Feinberg School of Medicine in Chicago.

A greeting by name is one way to make sure doctors treat the right patient, researchers said. And better communication leads to better outcomes.

"You will obviously get more information from a patient who feels more comfortable," said co-author Marianne Green, MD, assistant professor of medicine and assistant dean for medical education at the Feinberg school.

Too much chatter

A second study, in the June 25 Archives of Internal Medicine, scrutinized audio recordings of 113 visits to 100 primary care physicians in the Rochester, N.Y., region in 2000 and 2001. Actors portraying new patients made the visits.

Doctors talked about themselves or their families in 34% of the cases, a figure that surprised researchers. Self-disclosures were heard throughout the visit but occurred most while taking a medical history or gathering information before a physical exam.

Some examples: a doctor saying he weighed less than the patient, one talking about avoiding military service and another commenting on renting office space.

Physician: Deep breaths. ... Lay down for me. I don't know. I think I'll be panicked about the college time. I'm not sure I'm ready for that in any way. My daughter went to camp this week and everybody's saying, "Isn't it so great?" And I'm like, "No! I hate it! It's quiet! I don't have any friends!"

Patient: I hear ya. Right, right, right. Yep.

Physician: No buddies to do things with!

Patient: Yup, yup.

Physician: ... All right. We don't like it! Now, did they give you an appointment for the stress test?

In 79% of the encounters, the doctor never came back to what the patient was discussing. Only 4% of physician disclosures were useful to the patient by providing education or other support, the study concluded.

Disclosure "didn't help the patient open up. It most often distracted the patient and the physician," said lead author Susan H. McDaniel, PhD, professor of psychiatry and family medicine at the University of Rochester School of Medicine and Dentistry.

Dr. McDaniel visited her doctor recently and heard more about the physician's trip to Italy than solutions to her health issues. "It wasn't until I was out in the parking lot, and I thought, 'Oh, my God. I forgot to ask my second question.' "

Dr. McDaniel's study found little evidence that sharing a doctor's experiences or beliefs improved the doctor-patient relationship.

"Active listening and empathy may be much more effective than self-disclosure," she said.

Dr. Gazelle, the Harvard professor, said she has seen female internists go into detail about family life, straying from the patient's concerns. "Physicians need more training in how to communicate with patients. That's really an important take-home message in both of these studies," she said.

The University of Texas Southwestern Medical Center at Dallas teaches medical students to introduce themselves to new patients, said James Wagner, MD, associate dean of student affairs. The school doesn't teach them to say patient names, but after reading the greetings study, Dr. Wagner said students will be taught to use patient names in introductions.

"If you get off on the wrong foot with somebody, they'll clam up and they won't talk to you. However, if you get off on the right foot, the information flows wonderfully," he said.

Doctors should consider cultural differences when shaking hands and using names, said Terry Stein, MD, director of clinician-patient communication for Permanente Medical Group in Oakland, Calif. Some cultures don't greet with handshakes, and some people prefer more formal use of names. She likes to refer to herself as Dr. Stein. A few patients thought she was a nurse until she corrected them.

Cardiologist Christie Ballantyne, MD, likes to use a handshake and smile to make new patients feel more comfortable. He often addresses them by first name as the visit goes on, and he likes to conclude with a handshake. The gesture sort of seals the deal, he said, that the patient agrees to follow his treatment plan.

"You want to have some kind of connection with them, so they trust you," said Dr. Ballantyne, director of the Center for Cardiovascular Disease Prevention at Baylor College of Medicine and the Methodist DeBakey Heart Center in Houston. "By then, I hope I have convinced them what their [health] risks are and what they need to do."

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ADDITIONAL INFORMATION

How do you say hi?

Physicians don't always offer the greeting patients want. Survey responses from 415 patients were compared with interactions in 123 visits.

PreferredActual
Shake hands
Yes78%83%
No18%17%
Patient names
First50%14%
Last17%33%
Both24%3%
Not used by physician0%39%
Physician names
First7%0%
Last33%30%
Both56%59%
Not used by physician0%11%

Percentages are rounded, "Don't know" answers are not included.

Source: "An Evidence-Based Perspective on Greetings in Medical Encounters," June 11, Archives of Internal Medicine

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Too much information?

A study of 113 new-patient visits to primary care physicians in the Rochester, N.Y., region showed that doctors shared personal information one-third of the time. Researchers said most self-disclosures were not useful to the patient. Some exchanges, like the following, could bring inadvertent competition to the patient.

Patient: I'm 6 feet, and she just told me I was 204.

Physician: Is that up a little bit for you weight-wise?

Patient: It might be up a few pounds. ... I used to jog and ... I just haven't.

Physician: See, 'cause I'm weighing more like 172, 173, and I'm 6 foot ... and I'm still running ... I'm still doing the 5 and 10 and 15 K's. The half-marathons and ...

Patient: So ... I'm 30 pounds heavier than you?

Physician: Right now, yeah.

Only 4% of physician self-disclosures were useful to the patient, the study said. In one example of a useful interaction, the doctor had the same condition as the patient:

Physician: I suffer from it myself.

Patient: Oh, you're kidding me?

Physician: Absolutely.

Patient: So what I'm saying to you is ... what you have? The exact same thing?

Physician: Exactly.

Patient: Oh, my gosh!

Physician: Exactly.

Patient: What a coincidence.

Physician: Basically ... the acids in the stomach are coming back up. That's the reflux. And that really irritates the lining of the esophagus.

Source: "Physician Self-disclosure in Primary Care Visits," June 25, Archives of Internal Medicine

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