Doctors do not address patients by name in half of first-time visits, even though nearly all patients want this personal greeting, according to new research from Northwestern University's Feinberg School of Medicine.

"Greetings may seem a rather mundane part of physician-patient communication, but they create a first impression that can affect the chance of developing a therapeutic relationship," said Gregory Makoul, lead investigator of the study, professor of medicine, and director of the Center for Communication and Medicine at the Feinberg School.

"Doctors may figure 'I know who you are, you know who I am, let's go'," noted Makoul. "This is just one little slice of the visit, but it sets a tone for the rest of the encounter and the rest of the relationship. How you introduce yourself really can matter."

Organizations that accredit physicians and training programs emphasize communication as a critical skill for physicians. But this skill may not come naturally to all doctors, so it's important to offer guidance on different aspects of communication such as greetings, Makoul said.

There has been little evidence to guide doctors about how they should greet patients or what patients actually expect. Makoul's study focused on finding out what patients think is an appropriate greeting. He also analyzed a sample of interactions between doctors and patients during first-time visits.

Makoul and his colleagues collected information from 415 phone surveys in which people were asked how they expect to be greeted by a doctor. Researchers also viewed and analyzed more than 120 videos of primary care visits in which the doctor and patient met for the first time.

The study, published June 11 in the Archives of Internal Medicine, reported that 78 percent of survey respondents wanted the physician to shake their hands. Nearly all patients wanted to be greeted by name, including 50 percent by their first name, 17 percent by their last name and 24 percent by both their first and last name. Most patients, about 56 percent, wanted physicians to introduce themselves using first and last names, while 33 percent expected last name and 7 percent expected first name.

Makoul's research team found a striking difference between expectations voiced in the phone surveys and the actual interaction between doctors and patients in the videos. While 83 percent of doctors shook hands in the videos, only half addressed the patient by name.

Based on the data, Makoul recommends a greeting strategy that uses first and last names for both doctor and patient. For instance, if Dr. Robert Franklin is meeting Jane Smith for the first time, he might say, "Jane Smith" Hi, I'm Bob Franklin." This strategy communicates respect, and the videos showed it was a comfortable form of introduction for most study physicians during first-time visits.

Using patients' first and last names is also a way to keep them safe. "Because greetings are one way to ensure proper identification of patients, this approach can improve patient safety," Makoul said.

Doctors also should plan to shake a patient's hand, but need to be sensitive to body language or other nonverbal cues that may indicate whether a patient does not want to or is not physically able to reciprocate or respond.

"Greetings will change in return visits and are a sign of how the doctor-patient relationship is developing," Makoul explained. "Doctors should have their own style. Our study simply provides evidence about elements they can incorporate into that style."

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Makoul's research was funded by the American Board of Medical Specialties Research and Education Foundation.

Contact: Marla Paul
Northwestern University