Scoring Hospitalist Etiquette

1Johns Hopkins Bayview Medical Center, Baltimore, MD

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 124


As physicians are forced to spend more time in “indirect” patient care activities, particularly on documentation, it has become difficult to establish meaningful physician–patient relationships. Dr. Michael Kahn proposed a checklist of 6 etiquette‐based behaviors as a strategy to improve physician rapport with patients. We hypothesized that the creation of a score for “etiquette‐based medicine” (EtBM) score could allow for the grading of physician etiquette.


Eight hospitalists were randomly selected at each of 3 hospitals in the greater Baltimore area and were shadowed by a single observer during a nonadmitting shift between May and June 2009. Hospitalists knew only that the observer was conducting a time–motion analysis. Each time the hospitalist entered a patient's room, the observer recorded whether “etiquette‐based medicine” behaviors were performed: (1) knocking or asking to enter the patient's room, (2) introducing oneself, (3) shaking the patient's hand, (4) sitting down in the patient's room, (5) explaining one's role in the patient's care, and (6) asking about the patient's feelings regarding the hospitalization or his or her illness. The EtBM score for each physician was characterized as percentages derived by dividing the number of times EtBM behaviors were performed by the number of opportunities to carry them out. Physician activities were recorded at 30‐second intervals and categorized as direct patient care (e.g., time spent with patients or their families), indirect patient care (e.g., documentation, coordinating care, writing orders), other activities (e.g., walking, administrative meetings, scholarly work), and personal activities (e.g., meals, restroom breaks, personal calls). Linear regression was used to assess whether EtBM scores were associated with physician characteristics.


The 24 observed hospitalists collectively saw 226 unique patients and had 389 patient encounters. The average shift length was 9.9 hours (SD, 1.9 hours), and the average length of each patient encounter was 12 minutes (SD, 9 minutes). Overall, 18% of hospitalists’ time was spent in direct patient care, 60% in indirect patient care, 13% in other activities, and 9% in personal activities. EtBM scores for the providers ranged from a low of 3% to a high of 44% (mean, 19%). Physician age, sex, and experience were not associated with EtBM scores. Physicians in the top quartile for EtBM score spent more time with each of their patients than those in the bottom quartile (14 vs. 12 minutes) and spent a greater proportion of their day in direct patient care (21% vs. 16%); both P < 0.05.


Higher EtBM scores were more common among physicians spending more time with patients and may represent a marker of patient‐centered care. However, EtBM behaviors were infrequently practiced by every hospitalist in the sample, thus indicating significant room for improvement.


S. Tackett ‐ none; D. Tad‐y ‐ none; S. Wright ‐ none

To cite this abstract:

Tackett S, Tad‐y D, Wright S. Scoring Hospitalist Etiquette. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 124. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed March 28, 2020.

« Back to Hospital Medicine 2011, May 10-13, Dallas, Texas.