Manners maketh the doctor

The other day I made a call to our local hospital to ask a colleague to see a patient of mine as a matter of urgency. I asked the switchboard operator to page the relevant on-call registrar who duly appeared on the other end of the line. Using “hello?” as his tense, inpatient, opening gambit wasn’t a good start. Call me old fashioned- and you wouldn’t be the first- but I like to know who I’m talking to, especially when I’m sharing the intimate details of a person’s medical history. So I, in turn, used my now familiar response of “to whom am I talking?” Followed shortly thereafter by my own introduction, including my name and the fact that I am local GP.

The rest of the conversation didn’t go well, in large part, I suspect, because he was overwhelmed by whatever joys that day had held and still offered and partly, I suspect, because to him a call from anyone, including a GP, was just one more way to add to those joys. I won’t bore you with the details of why I called but will instead pursue my thesis that manners maketh the doctor.

In common with most of the British public (there was a survey about this recently) I believe that my manners are better than most. That a majority of us believe we are politer than the majority reveals a common lack of insight I may well share. And so I admit this conceit because to deny it would be futile. I am the old fashioned daughter of an old fashioned nurse and, for better or worse, being what I consider polite is central to how I practise.

Which is why introductions matter to me and why I don’t use the electronic notice boards in my practice, the type that allows the doctors and nurses to notify patients to come to their rooms. Some patients spend their entire time in the waiting room staring anxiously at the display, worried that they might miss their turn. And so, if they haven’t seen me before, they’re sometimes apologetic when I come to the waiting room to meet and greet them and walk them down to my room. They assume they’ve missed their name and forced me from my chair.

To ease their unnecessary embarrassment I often make a jokey remark about how I’m rather old fashioned, averse to this impersonal technology. They usually laugh, agreeing tacitly that my approach is a little quaint.  Meanwhile we’ve met eye to eye, they as Mrs Jones or Mr Brown, I as Dr Kirklin, and as equals we walk down to my room. A luxury, I’ve sometimes been told by colleagues.  Something they don’t have time for. But observe our walk and you’ll see the consultation is well under way and that this isn’t wasted time.

Not because we talk of medical things. It would be impossible to do so and to respect their confidentiality. But it is equally impossible not to begin to observe all manner of things: their walk, their demeanour, their confidence or lack thereof, whether they are in pain, physical or emotional. The walk is sometimes short, sometimes a little longer, depending on the office I’m working in and the vigour of the patient. By the end of the walk, as the patient enters the room, invited in by name- “please come in Mr Smith, do sit down”- I like to think we are ready to begin.

I realise that this degree of formality might seem outdated and unnecessary to my younger colleagues. Perhaps. And yet I see parallels in bypassing it and the “hello?” of the young registrar that disturb me. I could after all have been anyone- a nurse on the ward, a relative, a local GP. He might have been mis-paged, not been the registrar I expected but instead, say, the on-call pharmacist. I wonder what he would have said if I hadn’t introduced myself. Presumably he would have stopped me at some point into my tale to ask who I was, to whom was he speaking?

When was it that junior hospital doctors stopped using even these basic social niceties when answering their calls? What difference, I wonder, does it make to the conversations that ensue and what difference might it make if they learnt once more to employ them? If I was a relative, anxious for news, and when each day a different doctor is my first port of call for news, how would I frame my questions, my concerns, faced with “hello” from an unknown, unnamed, disembodied voice? Would I feel confident that the care being received was characterised by continuity and accountability, or would I instead feel unsure in the end about what role this unnamed person played in the system of care being received, in the most passive of sense, by my loved one?

Or what if I was a nurse, calling for help from whichever doctor was responsible for say  respiratory patients that night.  “Hello?” wouldn’t be what I was looking for. No, what I’d be looking for is someone confident in their own person and in their role. Respectful enough of mine to show me the common courtesy of introducing themselves.

And maybe that’s really where the problem lies, confidence. Maybe it isn’t just that these doctors have forgotten their manners, maybe it’s also that they’ve lost confidence in themselves and their ability to respond to the many individuals they interact with as anything other than a series of unwelcome problems. Engage with your colleagues, establish real rapport with your patients and they might just ask more of you than you have left to give.

We’ve all been there of course. We remember what it’s like to be exhausted, to have too much to do and to have to do it all at once. But what I don’t remember is putting aside all attempts to observe the simple niceties of communication between two individuals. I don’t think that doing so can make a difficult job any easier. Anymore than missing the vital clues available to the acute observer in the walk from waiting room to office helps the GP to do their job. So a plea to the next generation, for their own sake as well as everyone else’s: introduce yourselves; tell us who you are; have confidence that it matters to us that we’re talking to you. You never know, we might even turn out to be on your side.

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