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Patient-centred communication


Fostering understanding

Overcoming barriers


Stern-looking male physician

Common complaints to medical regulatory authorities (Colleges)

The doctor...
  • didn't listen
  • was rude
  • ignored my concerns
  • discriminated against me

Your parents probably stressed the importance of good manners.

Etiquette-based medicine simply means bringing politeness into the patient interview. Even before asking about the patient's condition or feelings, remember to:
  • Knock on the door and announce yourself prior to entering an examination room.
  • Introduce yourself and state your level of training.
  • Sit down to face the patient.
  • Explain your role in the patient's care.

Politeness also means paying attention:
  • Listen actively
    • summarize or paraphrase the patient's statements
    • try to make eye contact.
  • Don't check your mobile device for email.
  • Write any notes unobtrusively.
  • If you refer to the medical record, explain what you are checking.

Good etiquette means not offending by word or action. Don't roll your eyes, sigh audibly, or laugh when patients have unusual or unscientific beliefs. Always let the patient know your intentions, whether asking personal questions or touching patients during a physical examination.

Case: A difficult 40-year-old man
Distraught-looking male crouching on floor

Background

A 40-year-old man, well known in the emergency department for seeking drugs and being disruptive and aggressive, presents with a headache and demands to be seen immediately. He smells of alcohol and when the nurse attempts to take his blood pressure he refuses and becomes verbally abusive. Upon hearing the confrontation and knowing this patient, the emergency physician enters the room to intercede.

The situation escalates with both the physician and patient shouting and shaking their fists. The patient later launches a legal action against the emergency physician, claiming verbal and physical assault.

Outcome

The investigation found no evidence of physical assault; however, the verbal exchange had been documented by nursing staff and witnessed by a third party. The patient claimed the incident caused him significant embarrassment and psychological damage.

The CMPA was unable to find support for the physician's actions: the medical experts believed the physician failed to take appropriate steps to calm the patient and defuse the situation.

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