Intended for healthcare professionals

Fillers Observing patients

The knock on the door

BMJ 1999; 318 doi: (Published 02 January 1999) Cite this as: BMJ 1999;318:40
  1. John Ward, physician
  1. Sheffield

    So much of the benefit from a medical consultation must depend on how comfortable the patient feels in the presence of the doctor, coupled, of course, with the attitude and behaviour of that doctor.

    Throughout my 27years of practice I have observed a physical sign, which greatly concerns and upsets me. Carrying out three busy standard medical clinics a week, this sign has hit me approximately once a month. I open the door to ask in a patient —“Hello, good morning” —I hope in a friendly and reassuring manner. As the patient walks in they knock on the door — align=baseline border=0>they knock on the door that I am holding open for them. Why? I can only assume they in some way feel in —“please, you do not have to do that” — but as yet have not done so.

    Perhaps they feel better for it, but not me. I have not measured or audited this phenomenon but my strong impression is that these are older patients, often from the east side of our city. Surely this must be telling us something of which we should be aware when thinking about our consultation technique. Colleagues to whom I have mentioned this phenomenon tell me that they have never noticed this. I wonder if any readers have made a similar observation?

    We welcome articles up to 600words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

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