Clients prefer hands-on doctors

People want a handshake when meeting physician for the first time

June 21, 2007|By Janet Cromley | Janet Cromley,Los Angeles Times

They're not asking for a soul shake, but most patients want their physician to at least shake their hand when first introduced and about half prefer to be addressed by their first name, according to new research from Northwestern University in Chicago.

The study, published last week in the Archives of Internal Medicine, involved a nationwide telephone survey of 415 adults. In it, researchers at Northwestern found that 50.4 percent of the respondents preferred to be addressed by their first name; 23.6 percent wanted to be addressed by first and last name; and 17.3 percent preferred to be addressed by last name.

More African-American respondents than Caucasian respondents -- 38.7 percent versus 13.1 percent -- preferred to be addressed by their last name, and a full 78.1 percent of all respondents wanted their physician to shake their hand.

The study also looked at how physicians greet patients. Analyzing 123 videotaped doctors' visits, the researchers found that although physicians shake hands with patients nearly 83 percent of the time, they address patients by name in only about 50 percent of initial encounters.

How physicians address patients has safety implications, says Gregory Makoul, director of the Center for Communication and Medicine at Northwestern's Feinberg School of Medicine, and lead author of the study. "Calling the patient by name ensures you've got the right patient in front of you. These little things matter."

But the importance of greeting someone by name and shaking their hand goes far beyond that. "People remember how their doctor greeted them the first time," Makoul says. "This is one of those mundane, small slices of the visit that has a lasting impact. It sets the tone for the rest of the encounter and for the doctor-patient relationship."

The study is intriguing but does have some minor problems, says Dr. Rika Maeshiro, assistant vice president of the medical education division at the Association of American Medical Colleges, which represents 125 accredited U.S. medical schools. The population sampled in the telephone survey was predominantly Caucasian and college-educated, with a mean age of 47.5 years. If it had been more diverse, with (for example) more elderly respondents included, the results may have suggested a preference for the more formal forms of address, she says.

Medical schools routinely teach communication skills, and the Accreditation Council on Graduate Medical Education, which accredits residency programs, requires program faculty to teach and assess residents on interpersonal skills and communication, says the council's communications manager Julie Jacob.

Despite this attention to communication skills, there are little hard data on what patients really want. Instructors are forced to make assumptions, Makoul says.

At University of California, Los Angeles, medical students are taught to introduce themselves by first and last name and to address the patient by Mr./Ms. followed by the last name. "We tell them it's better to err on the side of formality," says Dr. Susan Stangl, an associate professor of family medicine and chair of UCLA's Doctoring 1 course for medical students.

Still, there will probably never be a one-size-fits-all greeting, she adds, because conducting a first interview is not an exact science. "You can have some general guidelines, but you can't preplan until you are there."

Handshaking, for example, is considered a gray area because some patients don't want to shake hands, for cultural or other reasons. Students are encouraged to use their judgment.

What really matters, Stangl says, is conveying respect, concern and caring. "You can't go wrong if you treat someone that way."

Janet Cromley writes for the Los Angeles Times.

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