PERSONAL VIEW
Doctors must
always introduce
themselves to
patients
After some staff didn’t introduce
themselves to her, the doctor
turned patient Kate Granger
launched her #hellomynameis
Twitter campaign, which has
struck a chord. It’s so much more
than just good manners
I
am lying on a trolley in the emergency department feeling extremely unwell. My temperature
is 39°C and my pulse 150 beats per minute. It
is about 36 hours since I underwent a routine
extra-anatomic stent exchange, and I have
developed sepsis. A young surgical doctor clerks
me in. He does not introduce himself by name,
instead plumping for “I’m one of the doctors.”
A nurse comes to administer my intravenous
antibiotics. She does not introduce herself at all.
Over the five day admission I lost count of
the number of times I have to ask staff members
for their names. It feels awkward and wrong.
Introducing yourself is the first basic step taught
in any clinical interaction for any healthcare
professional, but do we ever stop and think
about how important this is? As the patient
you are in an incredibly vulnerable position.
The healthcare team knows so much personal
information about you, yet you know next to
nothing about them. This results in a very one
sided power imbalance.
One way to begin to redress this imbalance is
a good introduction. I believe it is the first rung
on the ladder to providing truly compassionate,
patient centred care. It is also vital in developing
that all important rapport and trust on which to
build a therapeutic relationship. Of course we all
wear name badges to identify ourselves on the
shop floor, but their purpose must be to reinforce
a verbal introduction rather than to replace it.
And the writing on many NHS identity cards
is often so small that it is unreadable from the
hospital bed for many patients.
It is the first step to discovering what
matters to that individual patient and
to putting their concerns first
24
So given its importance, why are we
sometimes failing to introduce ourselves
properly? Do we blame time pressures?
Compassion fatigue? Perhaps a failure to put
ourselves in our patients’ shoes? This is all too
real for me, and my experiences as a terminally
ill patient with cancer have sharpened my focus
on how I care for others, particularly when it
comes to communication. I usually introduce
myself as Dr Kate Granger and then ask how the
patient would like to be addressed, always using
their surname in the first instance. Personally, as
a patient I like to be referred to as Kate, allowing
me to be in patient rather than doctor role.
However, everyone is different, and some people
feel more comfortable with a formal approach.
What is important is that we find out and put our
patients at ease.
Given my observations about the lack of
simple introductions, I wanted to make a
positive change. The NHS complaints procedure
seems rarely to lead to tangible improvements.
Therefore, as a keen exponent of social media
I started a campaign on the microblogging
network Twitter, using the hashtag
#hellomynameis. The idea was to reinforce the
valuable nature of introductions and to ask
people throughout the care sector to pledge their
commitment to introducing themselves properly
to each and every patient they meet.
The idea has been embraced by staff from
all corners of the NHS, from chief executives
and medical directors to healthcare assistants,
student nurses, and laboratory staff. I have
had nearly 200 pledges on my blog (http://
drkategranger.wordpress.com/2013/09/04/
hellomynameis) and too many tweets to count
(see box on bmj.com).
Many trusts are backing the campaign at
board level—for example, West Hertfordshire
Hospitals NHS Trust discussed #hellomynameis
at their daily meeting, and it was the central
topic of the chief executive’s weekly blog (www.
westhertshospitals.nhs.uk/newsandmedia/
chiefexecutiveblog). The chief executive at Yeovil
District Hospital discussed #hellomynameis
with all his ward managers. At Ipswich
Hospital’s emergency department they added
the hashtag to the observation chart clipboards
as a simple reminder to all staff.
The campaign has caught on in a short space
of time, and the feedback has been amazingly
positive, with many healthcare professionals
admitting that they had slipped into bad habits
but were now inspired to improve. This is a
simple change. It costs nothing and takes only
seconds, but it improves patients’ experience
of healthcare. It is the first step to discovering
what matters to that individual patient and to
putting their concerns first. I am proud of the
care I provide, and want my patients to know
my name. I want their families to know they
can ask for me. Hiding behind NHS anonymity
does nothing to improve the human connection
on which compassion and empathy are built.
A proper introduction is more than a common
courtesy—it is fundamental to providing
excellent and safe care.
Kate Granger is a registrar in elderly medicine and cancer
patient, Yorkshire [email protected]
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally
peer reviewed.
Cite this as: BMJ 2013;347:f5833
bmj.com
̻̻Communication in difficult situations: what would a
friend say? (BMJ 2013;347:f5037)
BMJ | 5 OCTOBER 2013 | VOLUME 347
LAST WORDS
FROM THE FRONTLINE Des Spence
The art of deception
Everyone lies. In their CVs, job applicants always were the captain of the
football, hockey, or something-else
team at school; played three musical
instruments, normally at the same
time; enjoyed debating; were head boy
or girl; and had also done good work
in Africa (a continent overflowing with
poorly constructed toilet blocks built
by hapless, unskilled, never-madea-bed teenagers). Truths, half truths,
and lying are the stock and trade of
life. I am always sceptical of what is
written until I can eyeball the author for
truthfulness.
Daniel Pelka died last year, aged
4, at the hands of his mother and
her partner. He joined a long list of
high profile cases dating back decades, including Peter Connelly, Victoria Climbié, Brandon Muir, Maria
Colwell, and Dennis O’Neill. Many
other forgotten children never received
this attention.
The recently published serious case
Understand that the
unbelievable story
is unbelievable
for a reason
Twitter
̻̻Follow Des Spence on
Twitter @des_spence1
review into Daniel’s death highlights
missed opportunities by professional
agencies to intervene. Doctors can
aspire to do better.
In this situation Daniel’s mother had
lied, explaining away signs of abuse
as medical conditions, such as an
eating disorder and learning difficulties. The report into Daniel’s death
encouraged professionals to “think
the unthinkable” and to be more questioning of parents’ explanations.1 This
runs counter to our culture of trust. But
it shouldn’t.
Patients lie to doctors all the time for
drugs, certificates, or referrals. Tears,
demands, threats, complaints, anger,
hostility, and defensiveness are the
indicators of manipulation and lying.
Patients from all backgrounds lie,
though sometimes in different ways:
aggression is aggression however passively and politely expressed. Women
and men are both capable of aggression, manipulation, and dishonesty;
most fabrications of illness in children
are perpetrated by mothers.2 This isn’t
cynicism but realism.
Much of medicine isn’t very nice;
some is downright unpleasant. Doctors
must learn to trust and distrust in equal
measure. Interpret body language, be
suspicious of inconsistencies, and
understand that the unbelievable story
is unbelievable for a reason.
Many of us have learnt this from
bitter experience, at school, in different
jobs and relationships, from the wise
words of our elders, and of course in
clinical practice.
Medical practice demands that we
use our intuition. Medical training
must be more honest, and it should
make clear the harshness of work.
Des Spence is a general practitioner, Glasgow
[email protected]
Competing interests: None declared.
Provenance and peer review: Commissioned; not
externally peer reviewed.
References are in the version on bmj.com.
Cite this as: BMJ 2013;347:f5889
IN AND OUT OF HOSPITAL James Owen Drife
Flying a desk
A hospital chief executive once sadly
remarked to me, “Very few doctors
can think at my level.” I remember
trying to ignore the gesture his hand
was making, rising as he said “my
level.” This was in the 1980s, when
the idea that a hospital secretary was
higher than a consultant was mildly
irritating. Today it is a given, and
doctors are being encouraged to aspire
to becoming a chief executive.
That ambition never crossed my
mind, perhaps because I grew up in
the wrong era. My favourite childhood
reading was Richmal Crompton’s Just
William books, about a boy who kept
subverting authority, and in the 1950s
we had war heroes like Douglas Bader,
an ace pilot despite being a double
amputee, who had scant respect for
bureaucracy.
In Reach for the Sky, the film of
Bader’s life story, he turns down an
administrative post because he hates
BMJ | 5 OCTOBER 2013 | VOLUME 347
the prospect of “flying a desk.” The
phrase was common in the air force,
where the distance between senior
staff and the real workers could be
measured on an altimeter. I first came
across it at an impressionable age, and
it stuck in my mind.
The film reinforced the idea that
rebels were in the right and had all
the fun. What a pity we kids had no
movies called, say, Managing Difficult
People, about the unsung heroes who
keep an organisation running. Or
Nottingham’s Greatest Sheriff, about
a man who rose to the challenge of
administering a medieval city while
under fire from reprobates who
kept shooting arrows through his
windows. Today’s youngsters are
similarly imprinted. International
corporations are now Hollywood’s
rent-a-villains.
In medicine, undergraduate
teaching may have moved from being
Bit by bit chief
executives are
taking over
the controls
pathology centred to patient
centred, but it is no closer to the
business school. Postgraduate
education focuses on how to
follow guidelines, not how to write
them. And as consultants become
more and more specialised, they are
less and less likely to think at a chief
executive’s level.
The idea of doctors running
hospitals seems more fanciful than
ever, but what about our professional
organisations? They too have
become businesses, and bit by bit
chief executives are taking over the
controls. Presidents come and go but
the chief executive is always there.
You need to put in hundreds of hours
before you can fly a desk safely, and
doctors just don’t have the time.
James Owen Drife is emeritus professor of
obstetrics and gynaecology, Leeds
[email protected]
Cite this as: BMJ 2013;347:f5832
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