Saturday, March 29, 2014

"Introductions" or "Why didn't they teach me how to say hello"

This is Scott Selinger and welcome to the first podcast on behalf of the Northern California’s chapter of the American College of Physicians Council of Early Career Physicians.  Given that this is our inaugural podcast, I thought it’d be a good time to talk about introductions - how you enter into that first meeting with a new patient and how you handle the name game.

Before I’ve done pretty much anything new in life, be it starting 6th grade, a new job, interviews, whatever - I’ve gotten a call from my dad where he just says: “remember first impressions.”  While this started out as rhetoric I would roll my eyes at, it’s become very important in my role as a physician, as I’m sure it has for every doctor out there.  That moment where you meet a patient for the first time is paramount in establishing trust and setting the tone of the rest of your relationship with them.

One thing that I’ve found is more important now, especially given how busy we all are in cold and flu season, is taking a moment to ready yourself before meeting that new patient.  We have so many other things are mind is on during the day - returning that page or email or message, following up on a lab, getting out on time - that it’s easy to let that ruin your first impression, your tone of voice, and your body language.  It’s crucial that your new patient knows that the only thing you’re thinking about while you’re talking to them is them.  Of course that can’t always be the case, but more and more I’ve found how helpful it can be before opening that door or pulling back that curtain, to stop, take a deep breath, put on a little smile, and focus on forging a great new doctor-patient relationship.

But then how do we introduce ourselves?  It’s probably a lot easier in the outpatient setting because by the time someone arrives in your office, they usually know who you are (and in many cases may have read a little blurb about you as well).  In the hospital, it’s a much more difficult setting - the new patient may not know why they are there (or even who they are), they may have already seen numerous other doctors and healthcare workers and have lost track of names, and they usually don’t know what every doctors’ role is (and why should they?).  

In both settings, it’s important that you clarify what your role is in their care.  It could be “I’ll be handling your day to day medical care and coordinating with our specialists, if needed” or “I’m here to talk with you a little about what’s been going on and start you on the path to getting better and then one of my colleagues will meet with you in the morning to check in and help guide your care from there” or “I’m here to be your go-to person for any aches, pains, rashes, coughs and colds that pop up and keep you as healthy as I can.”  This is important and often overlooked as the last thing you want is to be finishing up your encounter and hear something like “so when is my doctor getting here?”

Now what’s in a name?  How do you introduce yourself to your patients?  Some people introduce themself as Dr. Smith, others as Dr. Adrian Smith, and still others just say Adrian Smith and then clarify their status as a doctor and their role.  I’ve found that people are pretty divided on this and a lot of it seems to come from where they trained as the east coast (and even the south coast where I trained) has a much more formal atmosphere in general than here on the west coast and I think that plays into what style of introduction you use.  

What I was taught, and I think most people had this same training, is that your patient should be addressed as Mr. or Ms. and you introduce yourself as doctor so-and-so.  I can’t count how many training videos for patient interactions I’ve seen that start this exact way.  But is this ideal in today’s world or is this part of the outdated paternalistic model of the patient-physician relationship?  Trying to find hard data out there in favor of this approach is difficult, but there are a lot of opinion pieces and blog posts talking about how being addressed as “Doctor” and keeping the relationship more formal helps preserve the sacred contract we have with our patients.  The point is that as much as we in medicine are being pushed towards a standard consumer business model, we’re not Steve from the cell phone store - we need to present ourselves as a steady shoulder for our patients to lean on when they’re hurt or afraid or angry or scared.

On the other side, a quick look through pubmed actually showed some evidence that patients prefer a more informal introduction.  A study done on about 250 patients in a military family practice setting last year showed that patients preferred to be greeted by their first name and for the doctors to introduce themselves by their last names.  A study a few years ago in a vascular surgery clinic showed similar results.  

There was also an interesting study from the Archives of Internal Medicine back in 2007 where they asked about 450 patients their preferences and then video taped the actual encounters.  Just over 50% of patients wanted to be addressed by their first names only, and almost another 25% wanted to hear their first and last names.  Interestingly, on video about ⅓ of physicians called patients by their last names and over half didn’t call their patient by any name at all and boy in those cases you really just have to hope you’re talking to the right person or that could get awkward pretty quickly.  Finally, the survey showed that just over half of all the patients wanted to hear their doctors first and last name, about ⅓ only needed their last name, and the videos showed that in this case, you can always get what you want as those percentages matched up pretty nicely.

As with most things in medicine though, there is no class 1A evidence here, there is no right answer, there is only the art of medicine.  There are broad guidelines with caveats that you should refer to your local susceptibilities and specialists to tailor things to your individual populations and really this does come down to the personalized, individual-focused medicine we’ve heard so much about in the news lately.  I personally walk into the room, call the patient by their full names (which helps to make sure I’m in the right room), tell them my full name and then sit down and start chatting because that’s what I’m comfortable with and what works with my patients.  I don’t care if they call me doctor since generally the vast majority of my patients are older than me and I feel a little awkward asking my elders to show me a sign of respect (which by and large they do anyway because that’s just how they were brought up).  Oddly, for the first time in my life I have a lot of people referring to me by my middle name, which sometimes appears to be my first name due to the layout on my webpage.  That I’m not ok with because while Scott Selinger is a dedicated physician, dog enthusiast, and Dallas Cowboys fan, I haven’t quite figured out who Jeff Selinger is, if not my evil alter-ego. 

But what do y’all do in your day to day practice?  Have you found this to be something you still haven’t figure out or did you long ago get into your introduction groove to the point where it’s now just automatic?  As always, we’d love to hear your feedback on this, so if you have any burning questions or comments, you can post them on our facebook page or email them to  And if you have time, be sure to head on over to our facebook page for the Northern California Chapter of the ACP Council of Early Career Physicians so you can find out more about the events going on in the chapter.


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