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June 19, 2007 — Most patients prefer their physicians to greet them with a handshake and to introduce themselves using their first and last name, according to the results of a survey reported in the June 11 issue of the Archives of Internal Medicine.

"Widely used models for teaching and assessing communication skills highlight the importance of greeting patients appropriately, but there is little evidence regarding what constitutes an appropriate greeting," write Gregory Makoul, PhD, from Northwestern University Feinberg School of Medicine in Chicago, Illinois, and colleagues. "The purpose of this study was to provide some guidance for medical students, residents, and practicing physicians by defining patient expectations for physician behaviors during the greeting stage of medical visits."

In a computer-assisted telephone survey of adults in the 48 contiguous United States, the investigators asked closed-ended questions about preferences for shaking hands, use of patient names, and use of physician names. To characterize patterns of greeting behavior in everyday clinical practice, they also analyzed an existing sample of 123 videotaped new patient visits.

Although patient expectations varied somewhat with patient sex, age, and race, most (78.1%) of the 415 survey respondents reported that they wanted the physician to shake their hand, 50.4% wanted their first name to be used when physicians greeted them, and 56.4% wanted physicians to introduce themselves using their first and last names.

Videotapes showed that physicians and patients shook hands in 82.9% of visits but, in 50.4% of the initial encounters, physicians did not mention the patient's name at all. However, physicians tended to use their first and last names when introducing themselves.

"Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior," the authors write. "Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names.... Greetings create a first impression that may extend far beyond what is conventionally seen as 'bedside manner.'"

The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2007;167:1172-1176.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

1. List accepted practices for beginning the medical interview.

2. Describe patients' preferences regarding greetings during medical encounters.

Clinical Context

The medical interview is one of the most important tools for any physician. In general, physicians and medical students are encouraged to shake hands with the patient, address the patient by name, and identify themselves and their role in the patient's healthcare. These elements are particularly important during the first interview with a new patient.

Despite the importance of the medical interview, there has been little research into patients' preferences in beginning their interaction with the physician. Many nuances of the greeting, such as whether to use the first or last name in addressing the patient, remain unclear. The current study addresses the subject of greetings in medical encounters from a patient-centered perspective.

Study Highlights

  • The study consisted of 2 parts. Researchers performed a telephone survey of US adults between 2004 and 2005. Trained interviewers asked subjects about their preferred greeting from physicians and specifically focused on handshaking and the use of first vs last names.
  • Researchers also examined an existing data set of videotapes of encounters between attending physicians and patients in 2 academic medical centers. A reviewer examined tapes from the first encounter between physician and patient to determine the prevalence of particular behaviors.
  • Cooperation with the phone survey was 28% among those invited, yielding 415 surveys for analysis. The mean age of subjects was 47.5 years, 63% of respondents were women, and 76% were white.
  • The video sample included 123 visits with 19 physicians. 60% of these subjects were women, and these subjects tended to be younger and more educated than those in the telephone sample. 68% of physicians in the videos were men.
  • 78.1% of participants interviewed by telephone preferred to shake hands with the physician. Older patients were less likely than younger patients to prefer a handshake, although most subjects of all ages preferred to shake hands. Conversely, the main result in this outcome did not vary by sex, education, or race/ethnicity. The videotapes revealed that 82.9% of encounters began with a handshake.
  • Rates of patients' preference for being addressed by their first name only, last name only, or both names were 50.4%, 17.3%, and 23.6%, respectively, in the telephone survey. A remaining 8.7% of subjects were not sure how they would prefer to be addressed. African-American patients were more likely than white patients to prefer being addressed by their last name.
  • Physicians mentioned the patients' name in only half of encounters on videotape.
  • Rates of patients' preference for the physician introducing him or herself by first name only, last name only, or both names were 7.2%, 32.5%, and 56.4%, respectively, in the telephone survey. 3.9% of subjects were not sure of their answer to this question. These preferences were mirrored fairly well in the videotaped encounters, with the exception that 11.4% of physicians did not introduce themselves.
  • More women than men and African Americans than whites preferred that the physicians use both first and last names when introducing him or herself.
  • Other physician characteristics of value to patients interviewed by telephone included smiling, being friendly, being warm and respectful, and being attentive and calm.

Pearls for Practice

  • Previous general recommendations for medical personnel beginning the medical encounter include shaking hands with the patient, addressing the patient by name, and introducing oneself and one's role in the patient's healthcare.
  • The current study suggests that patients want to shake hands with their physician and have the physician introduce himself or herself by first and last name. White patients may prefer to be addressed by their first name, whereas African-American patients may prefer to be addressed by their last name.

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