Excerpts from the book Manners, Morals and Medical Care: How To Be an Effective Physician
By: Barry Silverman and Saul Adler
posture, leaning towards you and nodding empathetically?”
When patients first encounter their physician, hospital or medical insurance company, their initial impressions of the care they will receive are shaped by the physical surroundings and the healthcare workers they encounter.
Consider the 25,000 square feet of an emergency department in a major southeastern hospital: Every hallway displays the sign “Courtesy & Respect.” Each evaluation and treatment room is spotless, shining, tiled and glass-walled.. Yet patients with non-life-threatening injuries or illnesses are left waiting for hours before being seen by a triage nurse or a doctor, and other patients pending admission wait for what must seem like forever to be admitted to as-yet-unassigned rooms. Meanwhile, their anxious families mark time in the waiting area, unaware of the fate of their family members or friends.
Maybe the hospital is understaffed or overcrowded, but it takes just a few seconds for the nurse or ward clerk to visit and reassure the patient they have not been forgotten, or to keep those anxiously waiting informed of their family member’s progress. Why should the hospital or doctor’s office behave differently from a restaurant, where diners are warned if they must wait for a table or are notified if their meal is delayed?
We expect common courtesy and good manners in business dealings. There is no good reason for your patient to settle for less in their medical care. Doctors and nurses work with patients at a most vulnerable period in their lives – during an illness – when listening attentively and encouraging questions are critical to your ability to provide good care. Yet not a day passes when a patient, family member, nurse, therapist or physician does not take offense or feel bruised by the callous, inattentive or disagreeable behavior of a colleague or coworker.
A compassionate caregiver treats patients with respect. Organized medicine recognizes the importance of respect for human rights and honoring patient dignity in providing care. The first of the AMA “Principles of Ethics” states physicians must respect human dignity and rights. The four commonly held principles of bioethics acknowledge the human dignity in every person and the requirement that each must be treated with and is entitled to respect.
You want to be the doctor who provides good medical care and has compassion for patients. If your actions in the patient encounter do not demonstrate respect, your patient might wonder about your commitment to his or her health. In the absence of compassion, your patient might view your opinion as to diagnosis and treatment as suspect, even self-serving, and will probably not heed any instructions or even return to your office for follow-up.
Of course, not every disagreeable encounter with a doctor or nurse is an indication of incompetence, just as not every individual display of good manners is an indication of a person’s essential morality. Ruthless dictators and sociopathic financial manipulators may display impeccable manners. But what is the patient to think if, when you enter the room, you do not state your name and your role, or when the nurse or technician who wakes your patient to change the bed linen does not murmur an apology?
Attention to good manners is particularly important in the hospital and medical office. Here, many barriers of social convention are altered: unilateral nakedness, conversations about ailments and intrusive questioning are all banned in civil company, yet these are critical to the medical encounter. With these barriers voluntarily dispensed with, the importance for you and your staff to act in accordance with other conventions of compassionate behavior – uninterrupted listening, solicitous attention to physical comfort, agreeable demeanor and pleasant surroundings – cannot be overstated.
A patient gets the impression of a doctor’s capability not from the physician’s medical expertise – few patients have the training to make that evaluation – but rather from the doctor’s concern for the patient as a human being. That concern is conveyed through manners, a willingness to consider the patient’s feelings, preferences and views, and an ability to communicate. The famous Johns Hopkins physician, Philip Tumulty, addressed the issue of communicating with patients in his 1970 address to third-year medical students:
Actually, what many patients miss and resent today is the inability to communicate with their physicians in a meaningful manner. Patients have questions they want answered, fears requiring dissipation, misunderstandings that need clarification and abysmal ignorance about themselves that demands enlightenment. Today, many patients with serious health problems leave their physician’s offices with less comprehension of what is wrong and what they must do to get well.
Manners, Morals and Medical Care is comprehensive, socially conscious and written in an engaging yet didactic narrative style.It can serve as an authentic source and entertaining guide on the responsibilities and expectations of a practitioner caring for patients. The book is available from Amazon or Springer Nature as a paperback or ebook.
Dr. Barry Silverman
Dr. Silverman practiced cardiology for 36 years and is currently on the volunteer Emory teaching faculty at Grady Memorial Hospital. He served in leadership roles with the Medical Association of Atlanta, American College of Physicians, American Heart Association, American College of Cardiology and American Osler Society. Dr. Silverman has received awards from Northside Hospital, the American College of Physicians, the Medical Association of Georgia and the American Heart Association.
Dr. Saul Adler
Dr. Adler worked in a pediatric clinic during his military service and then received his neonatology fellowship training at Boston Lying-in Hospital, now the Birmingham and Women’s Hospital, in Boston. While in the faculty at the University ofSouth Florida Medical School, he established the first community-based, specialty-trained, nursing-staffed neonatology unit.
