Journal of General Internal Medicine

, Volume 28, Issue 7, pp 908–913 | Cite as

Appraising the Practice of Etiquette-Based Medicine in the Inpatient Setting

  • Sean Tackett
  • Darlene Tad-y
  • Rebeca Rios
  • Flora Kisuule
  • Scott Wright
Original Research



The physician–patient relationship is at the heart of patient care. Dr. Michael Kahn proposed a checklist of six behaviors, defining “etiquette-based medicine”, as a strategy to start each encounter respectfully and improve patient–physician rapport.


To assess performance of “etiquette-based medicine” in the inpatient setting.


Cross-sectional observational study using time-motion techniques between May and July, 2009. Eight hospitalists were randomly selected at each of three hospitals in the Greater Baltimore area. Each time the physician entered a patient’s room, a single observer recorded whether the “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 his or her hospitalization or illness.


The frequency with which physicians performed the six behaviors, predictors of behavior performance, and Press-Ganey performance scores. The etiquette-based medicine (EtBM) score was defined and calculated by dividing the number of observed behaviors by the number expected.


The 24 observed hospitalists collectively saw 226 unique patients. No individual behavior was performed with a majority of patients, and, with 30 % of the patients, none of the behaviors were performed. The average EtBM score for the physicians was 22.3 % (SD 10.9 %). Physicians who spent more time with patients were more likely to perform behaviors. Sitting down (p = 0.026) and EtBM scores (p = 0.019) were associated with physician-specific Press-Ganey ratings.


Cross-sectional design does not allow for determination of causality.


“Etiquette-based medicine” was infrequently practiced by this sample of hospitalist physicians. Improving performance of etiquette-based medicine may improve patient satisfaction.


etiquette-based medicine professionalism hospitalists 



Dr. Wright is a Miller-Coulson Family Scholar and this work is supported by the Miller-Coulson family through the Johns Hopkins Center for Innovative Medicine. We are grateful to Supriya Munshaw for her statistical expertise. This work was presented as a poster at the two national conferences: Society of Hospital Medicine’s Annual Meeting in Dallas, TX, May 11, 2011, and the Society of General Internal Medicine Annual Meeting in Phoenix, AZ, May 4, 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Sean Tackett
    • 1
  • Darlene Tad-y
    • 2
  • Rebeca Rios
    • 1
  • Flora Kisuule
    • 1
  • Scott Wright
    • 1
  1. 1.Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of MedicineBaltimoreUSA
  2. 2.University of Colorado Anschutz Medical CampusAuroraUSA

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