Address patients by Mr/Mrs or first name?

[ERDude]

For any adult patient I walk in the room and greet them by Mr/Mrs LastName and then introduce myself as Dr. Lastname. I will change to first name if they ask me to. I find that the vast majority of the RNs, techs, and other personnel default to addressing patients by their first name.

What do y'all do?

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[Birdstrike]

For any adult patient I walk in the room and greet them by Mr/Mrs LastName and then introduce myself as Dr. Lastname. I will change to first name if they ask me to. I find that the vast majority of the RNs, techs, and other personnel default to addressing patients by their first name.

What do y'all do?

I confirm entire name, ie, "Hi I'm Dr Bird. And you are .....Jose Rose? Good to meet you Mr Rose. What can I do for you today?"

Occasionally you'll click on the wrong patient or walk into the wrong room and it's good to know that immediately not after you've gotten too deep in the weeds. The quickest way to do that is simply confirm correct patient my name, avoiding the Mr, Mrs, Ms, stuff.

I also always do an open ended introduction to all others in the room: "Good to meet you too, and you are his......" and let them fill in the blank. That avoids the "Aw shucks, I though you were his grandmother, but jeez, you're dating! Oops! Hardee har. Times really have changed. Sorry." type situation. If they don't give it up, then I follow with, "...friend? Family?" I've yet to have anyone get offended when asked if they are friend or family. That will usually prompt them to cough up some relation, ie, "No, actually I'm his parole officer, partner and 3rd cousin, too. 🙂"

"Okay. Fantastic. Now tell me about the stubbed toe and disability paper work you're requesting to be filled out on Christmas at 3am..."

Also, I think people like it when you confirm proper pronunciation also. "Is that pronounced Rose or Rosé (Roe-zay)?"



"You okay, today, José Rosé?"

 

[Hair Police]

My usual opening conversation goes something like this:

Me: Hello, I'm Dr -, are you Mr John Doe?
Pt: Yes
(Assuming there's someone else in the room)
M (turning to the other person): And you are...?
Other person: I'm Jane/girlfriend/wife/etc.
M (turning to pt): Do you mind if we talk about medical stuff in front of Jane?
Pt: Yes/no
M: How can I help you today?

(Note I don't say what's your problem, or what brings you in, what's your complaint, etc. "How can I help" gives me the highest percentage of non-joking, direct, and honest answers in my limited experience.)

Also, just because someone else is informal, doesn't mean I should be. Patients come for the doc, so I give them the professionalism to match those expectations. I don't see it as a 'service' issue. It just quickly creates an effective doctor-patient relationship, which helps me address that patient's issue so I can get onto the next's.

 

[Apollyon]

M (turning to the other person): And you are...?
Other person: I'm Jane/girlfriend/wife/etc.

What I get, as a rule, is "Betty". I have to ask further as to what is the relationship. It virtually NEVER is "wife/gf/boss", etc.

As it is, I walk in and say, "My name is "John Smith". I am the doctor working in the emergency department today/this evening/this morning. What is going on this evening that you come to see us?"

And second the, "even if the patient is informal, I am not."

 

[shookwell]

I always ask what their name is when I first come into the room and call them whatever they say

 

[Arcan57]

For bonus patient satisfaction points: instead of asking the patient what's wrong/how can I help - summarize what the nursing/triage note said. Sample opening script:

Hi <Pt's title and last name if I think I can pronounce it>, I'm <First Name> <Last Name>, I'm the emergency doctor. I'm going to take very good care of you today. I'm sorry that you had to wait so long (optional). The nurse was telling me that you've been having (chief complaint). When did you start feeling bad?

Either they launch into the time course or they correct me with why they're actually here. But it makes the patient feel like they're not just regurgitating the same information for the 3rd time, even though in general that's exactly what's happening.

For peds I warmly greet pt by first name before delivering above intro to adults in the room. I also ask any adult visitors what their relationship is to the patient. It's hard to recover from confusing wife for mom.

 

[WilcoWorld]

For bonus patient satisfaction points: instead of asking the patient what's wrong/how can I help - summarize what the nursing/triage note said. Sample opening script:

Hi <Pt's title and last name if I think I can pronounce it>, I'm <First Name> <Last Name>, I'm the emergency doctor. I'm going to take very good care of you today. I'm sorry that you had to wait so long (optional). The nurse was telling me that you've been having (chief complaint). When did you start feeling bad?

Either they launch into the time course or they correct me with why they're actually here. But it makes the patient feel like they're not just regurgitating the same information for the 3rd time, even though in general that's exactly what's happening.

For peds I warmly greet pt by first name before delivering above intro to adults in the room. I also ask any adult visitors what their relationship is to the patient. It's hard to recover from confusing wife for mom.

Agree with this. I would add that, for bounce-backs or frequent fliers, it's good to start with "I've reviewed your case, and I see that you came in today because xyz."

 

[Old_Mil]

Under 20, first name. Otherwise Mr./Ms....i

 

[shookwell]

Agree with this. I would add that, for bounce-backs or frequent fliers, it's good to start with "I've reviewed your case, and I see that you came in today because xyz."

I do this too.

Almost every patient interaction starts with:

"Hi, I'm <name>, I'm going to be your doctor. What's your name?"

"how are you feeling?"

if they don't immediately start talking about their chief complaint or if they say something non-committal like "fine", then I ask directly about the complaint that's in the triage note

"I heard you have been having some chest pain. Can you tell me about that?"

 

[dchristismi]

"Hi there Mrs Smith, I'm Doctor Me, and what brings you in today? (Or "and how can I help you?")

Never first name, unless under 20. But then again, my average patient is in their 80s. And I do what the prior poster does and ask "and you are her...?" to get family relations (and POA) - sometimes explaining that I have put my foot in my mouth too many times, and it's always good to know who's the mistress and who's the wife *winkwink*.

For my frequent fliers, it's more like: "Paul, Dude, what happened?" We don't have a lot of them, but you do get to know your regulars.

 

[xaelia]

Agree with this. I would add that, for bounce-backs or frequent fliers, it's good to start with "I've reviewed your case, and I see that you came in today because xyz."

Or, as the case may be, "I've reviewed your records and I see you signed out of the hospital next door AMA because they weren't giving you the Dilaudid you wanted."

Yep, on my last night shift two days ago. He/she won't be getting a satisfaction survey.

 

[WilcoWorld]

Or, as the case may be, "I've reviewed your records and I see you signed out of the hospital next door AMA because they weren't giving you the Dilaudid you wanted."

Yep, on my last night shift two days ago. He/she won't be getting a satisfaction survey.

Because you admitted him/her?

 

[xaelia]

Apparently, certain diagnoses and complaints can go on a satisfaction survey exclusion list.

 

[WilcoWorld]

That's great if your shop does that. My shop still surveys Psych patients and people we have "care plans" in place for due to known, documented abuse of the system. These are just some of the reasons I base my sense of self-worth solely on PG results.

 

[Birdstrike]

These are just some of the reasons I base my sense of self-worth solely on PG results.

Atta boy. Coming along finally.

 

[RustedFox]

My script for greeting a patient:

*Approach doorway*

"Hi ! I'm looking for (Firstname Lastname)."

This usually prompts a response from the patient, if they're A&O. If no response:

"Did I find (him/her)?"

"Yes? Ah... Good... I'm Doctor RustedFox; I'm here to get you feeling better today. Who did you bring with you?"

Do not underestimate how important it is to acknowledge and involve family. Phrases that really make a difference:

"Thank you for bringing Firstname Lastname here today."
"Clearly, you have a family that cares about you very much."
"This is your (wife/husband)? How long have you been married? What's the secret to staying together for so many years?" (Especially if senior citizen couple).
"It seems to me like you've got some people to help you get thru the rough parts, should they come."

 

[shookwell]

Because you admitted him/her?

Patients with psychiatric and substance abuse diagnoses are usually excluded. It's pretty easy to add one of those, even if it's just tobacco use.

 

[WilcoWorld]

Patients with psychiatric and substance abuse diagnoses are usually excluded. It's pretty easy to add one of those, even if it's just tobacco use.

I have heard this before, and I accept that it may be the case for a lot of places. However, when I specifically asked my administrator about this I was told that we do not exclude psychiatric and substance abuse diagnoses "Because they are our patients too."

 

[Birdstrike]

I have heard this before, and I accept that it may be the case for a lot of places. However, when I specifically asked my administrator about this I was told that we do not exclude psychiatric and substance abuse diagnoses "Because they are our patients too."

And they see no conflict of interest there (more likely they choose to ignore) in that those with active mental illness or substance abuse may be most "satisfied" with those exact treatments most harmful to them, and most dissatisfied when best treatments are offered. They also choose to ignore the toxic bind that puts a physician in, having to choose between violating his/her oath by having to "keep patient satisfied by harming them and securing his own job," versus "dissatisfying the patient, by doing what's best for them and therefore risking his own job," by ensuring sub-goal satisfaction scores. If they have their way, they'll kill any sense of oath or ethics in physicians other than the Oath to the Money Making Machine, before it's all said and done. The only mantra they'll have physicians chanting is, "Profits Over Patient Care, Profits Over Patient Care..."

 

[Arcan57]

We include psych/drugseekers for PG as a timing thing. We do phone calls. If we excluded them,the time it takes to abstract the chart to filter them out means the call happens after the bill drops. Since satisfaction drops markedly after patient gets the bill, we take the hit on the 2-3% of our patients with substance abuse/psychosis vs 100% of our patients that are disappointed about the $2000 bill for their kid's viral uri workup.

 

[GeneralVeers]

I've inquired repeatedly about the conflict of interest that Birdstrike raises. Every time I've been told condescendingly that it's "How you explain your treatment plan to the patient, not the plan that satisfies them!".

These people really believe that if you tell Mr. DrugSeeker nicely that you aren't giving narcotics, that somehow their lives will be changed and they give you all 5's.

 

[Birdstrike]

I've inquired repeatedly about the conflict of interest that Birdstrike raises. Every time I've been told condescendingly that it's "How you explain your treatment plan to the patient, not the plan that satisfies them!".

These people really believe that if you tell Mr. DrugSeeker nicely that you aren't giving narcotics, that somehow their lives will be changed and they give you all 5's.

They know that's a lie. They also know it's your license on the line and prefer you to look the other way to increase their profits by keeping all patient volume maximally high.

 

[Arcan57]

I've inquired repeatedly about the conflict of interest that Birdstrike raises. Every time I've been told condescendingly that it's "How you explain your treatment plan to the patient, not the plan that satisfies them!".

These people really believe that if you tell Mr. DrugSeeker nicely that you aren't giving narcotics, that somehow their lives will be changed and they give you all 5's.

Obviously that belief is wrong. However for the vast majority of EPs, it's not the drug-seekers that are going to make or break your PG scores. Unless you're working in hell, seekers should be no more than 5% of your discharged patients. Assuming relatively constant national scores and enough surveys to have reasonable statistical validity (I know that's a big assumption), you can have 1/10 of your patients give you 0's across the board and still hit the 90th percentile.

 

[shookwell]

Obviously that belief is wrong. However for the vast majority of EPs, it's not the drug-seekers that are going to make or break your PG scores. Unless you're working in hell, seekers should be no more than 5% of your discharged patients. Assuming relatively constant national scores and enough surveys to have reasonable statistical validity (I know that's a big assumption), you can have 1/10 of your patients give you 0's across the board and still hit the 90th percentile.

The main problem with Press Ganey is that there is no statistical validity as the sample size is way too small. You are assuming something that is demonstrably false.

 

[goldenboy48]

My usual opening conversation goes something like this:

Me: Hello, I'm Dr -, are you Mr John Doe?
Pt: Yes

That can be problematic. Some patients who don't English or can't understand you will just say yes for the sake of it. Always get the patient to say their identification.