'Etiquette-based medicine' in the hospital

What if doctors had better manners?

Politeness can never replace compassion, but a Beth Israel Deaconess doctor makes the case for what he calls "etiquette-based medicine" in this week's New England Journal of Medicine.

Psychiatrist Dr. Michael W. Kahn has been paying attention to what patients complain about when they're not happy with their doctors. Often what they mind the most is a rushed, impersonal brusqueness, he writes.

He experienced the opposite when he became a hospital patient himself. His European-born surgeon had Old World manners, with impeccable dress, body language, and eye contact that had a remarkably calming effect.

"It helped to confirm my suspicion that patients may care less about whether their doctors are reflective and empathetic than whether they are respectful and attentive," he writes.

There's nothing wrong with bringing a little Nordstrom's service into the hospital, he said. He suggests teaching some of the legendary retailer's customer satisfaction approach to medical students and residents. It can complement compassion, which is much harder to teach, making etiquette instruction the low-hanging fruit of medical education.

"Everyone talks about the decline of civility and this is just one aspect of a larger societal issue," he said in an interview. "But I think the stakes are bigger in the hospital because people are more anxious."

Here's his etiquette checklist:

1. Ask permission to enter the room; wait for an answer.

2. Introduce yourself, showing ID badge.

3. Shake hands (wear glove if needed).

4. Sit down. Smile if appropriate.

5. Briefly explain your role on the team.

6. Ask the patient how he or she is feeling about being in the hospital.

"Here's something that's really simple, costs nothing, and you can't argue with it," he said.