Paging Dr. Friendly

June 12, 2007 — -- For 29-year-old Kirran Bari of Boston, prescriptions and medical tests aren't enough to make her feel completely comfortable around a doctor she has just met.

What does she demand? A friendly introduction, for starters."With the initial greeting, you can tell whether your doctor is genuinely interested," Bari says. "You notice that first impression."

And Bari may not be the only one who prefers a more personal approach from a physician, a new study suggests.The research is published in the latest issue of the journal Archives of Internal Medicine.

Gregory Makoul and his colleagues at Northwestern University Feinberg School of Medicine surveyed more than 400 patients in 48 states to find out what patients prefer during an initial encounter with a doctor. The authors reviewed 123 videotaped patient visits to see what the 19 doctors at two study sites actually did during an initial visit.

What they found was that nearly 80 percent of the patients surveyed want to shake their doctor's hand -- and about half prefer that their physician use their first name during that initial encounter."Doctors are told to greet patients appropriately, but we rarely tell them exactly what to do," says Makoul. "The point of this study was to provide evidence to help doctors know what to do."

Handshakes All Around?

Doctors seemed to comply with the hand-shaking demand Makoul's group identified. The physicians they followed shook hands with patients in over 80 percent of their visits. "I prefer that they shake my hand because I am concerned with not just being treated as a disorder," says 66-year-old L. Robert Griffin of New Hope, Pa. "I prefer some sort of normal-person contact."

Indeed, many physicians see shaking hands as essential to the personal relationship between patient and doctor."It is frankly critical that the first meeting include shaking hands with the patient and with any family or friends they have brought," says OBGYN Dr. Joanna Cain, director of the Center for Women's Health at Oregon Health Sciences University. "After we have seen patients for a period of time, hugs are as common as handshakes," Cain says.

Dr. Christie Ballantyne of the Methodist DeBakey Heart Center and Baylor College of Medicine says that the handshake may be even more important at the end of the visit."I very much feel that a handshake after going over what we have agreed upon as a plan is like 'making a deal,'" says Ballantyne.

But what might be the health implications of shaking the hand of a person who spends his or her day around sick people? Makoul says patients "[W]ould want doctors to wash their hands. You don't know if they've done that before they've walked in or not."

But he adds that many doctors will take the effort to wash their hands in front of their patients before greeting them. And a lot of patients really couldn't care less anyway."People probably aren't that turned off of handshakes in terms of hygiene," he says.

The Name Game

The doctors in Makoul's study fared worse with names, though. Virtually all patients surveyed preferred to be addressed by name -- whether first, last, or both -- but physicians did not mention their patient's name at all in over half of initial encounters.

Being addressed by name does matter to many patients, however. "It's typical politeness and personalization," says 30-year-old Gordon Roble of Boston. "I prefer that doctors call me by my first name -- it's more personal," he added. Roble's preference reflected the opinion of more than half of the patients in the study.

Dr. John Minna of University of Texas Southwestern Medical Center thinks that there may come a time when a doctor greets his or her patient by first name, but that time is not the initial encounter."It is very important to use names and to start with a more 'formal' approach," he says. "For example, 'Ms. or Mr. Patient, I am Dr. John Minna.'"

Dr. Harold Nelson, professor of medicine at National Jewish Medical and Research Center, agrees that after a sustained patient-doctor relationship, addressing a patient by their first name may evolve.

"For new patients I never use their first names, but for old, familiar patients I always do," says Nelson.

Other doctors prefer not to use first names -- ever."I am old fashioned; I don't use first names and do not want my patients to call me Pat," says Dr. Patrick Walsh, professor of urology at Johns Hopkins.

Walsh's position on first names was supported by the study results: not one of the physicians they followed introduced themselves by first name only. Over half used both their first and last names, which was about the same proportion of patients who preferred the same.

No Universal Script for Doctors

Although the study suggests that most patients prefer shaking hands and being called by their first name, Makoul notes that the study's conclusions are not a template for everyone."The things we're recommending are based on a survey and what we saw on video," says Makoul. "There's no script to follow, and we're just trying to provide evidence based on the patients and doctors we studied."

Physicians should remain sensitive to nonverbal cues that might suggest if a patient wants to shake hands, or if they want to be called by their first name."The greeting itself, while it may seem mundane and not significant, can set the tone for the rest of the encounter and the patient-physician relationship," says Makoul. "Each doctor will have their own style."