A 49-year-old woman is transferred from a community hospital to a tertiary care center for management of an acute exacerbation of chronic obstructive pulmonary disease. The patient receives care overnight from a hospitalist, who transfers care to the teaching service in the morning. The medical team now responsible for the patient meets with her for the first time during morning rounds. The attending physician introduces the team and explains that the patient will be interviewed by the intern. The patient then addresses the intern by his first name and mentions, "You remind me so much of my son. He's very smart and looks a lot like you." Which of the following actions by the intern would be most appropriate to begin the interview?

Question

A 49-year-old woman is transferred from a community hospital to a tertiary care center for management of an acute exacerbation of chronic obstructive pulmonary disease.  The patient receives care overnight from a hospitalist, who transfers care to the teaching service in the morning.  The medical team now responsible for the patient meets with her for the first time during morning rounds.  The attending physician introduces the team and explains that the patient will be interviewed by the intern.  The patient then addresses the intern by his first name and mentions, "You remind me so much of my son.  He's very smart and looks a lot like you."  Which of the following actions by the intern would be most appropriate to begin the interview?

Quizplus · Accepted Answer

Building a therapeutic physician-patient relationship requires finding an optimal balance between friendliness and professionalism. First impressions are important, and initial encounters with new patients often set the tone for the ensuing relationship. Using the patient's preferred form of address can help build rapport. Clarifying any uncertainties about pronunciation, titles, or pronouns is important as well. Although younger adults often prefer being called by first name, older patients may take offense at what they consider undue familiarity. When in doubt, the physician should ask patients their preferred form of address. As familiarity develops between the physician and patient, many patients will prefer to be addressed by first name. However, it should be the patient, not the physician, who takes the lead in lowering the level of formality. It is better to ask the patient's preference in an open-ended manner rather than make assumptions. (Choices A and B) Although the patient has addressed the intern by his first name, it is still inappropriate to assume that she wants to be addressed by her first name. The patient's preferred form of address should be clarified first. (Choice C) This patient has expressed positive feelings toward the intern because he reminds her of her son. Using her surname without clarifying if that is her preference shifts the tone of the interaction and may be perceived as overly formal and distant. Asking her preferred form of address would be best. (Choice E) Initiating an interview by instructing or correcting the patient in front of the medical team, no matter how gently or politely, may embarrass the patient and result in deterioration of rapport. Educational objective: Initial encounters with new patients often set the tone for the physician-patient relationship. When in doubt about how to address patients, the physician should ask them their preferred form of address. __________ References: Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. (http://www.ncbi.nlm.nih.gov/pubmed/28148254) Medical communication: the views of simulated patients. (http://www.ncbi.nlm.nih.gov/pubmed/29600570)

A 49-Year-Old Woman Is Transferred from a Community Hospital to a Tertiary