Knock, knock: exam-room etiquette

You’re waiting in the exam room and finally hear a knock at the door, announcing that the doctor has arrived.

What happens next? A) The doctor flings open the door; B) The doctor waits for your response before opening the door.

This little nuance of the doctor-patient encounter was discussed at some length recently in one of the online patient forums. It started with a question from someone: “Have you ever noticed – they knock on the door a couple of times and then barge right in without waiting for a response.”

Whether the doctor knocks and waits for permission to come in might not seem like a big deal. To a busy physician who’s racing to stay on schedule, it might even be a pointless, unnecessary delay.

Where the doctor-patient relationship is concerned, however, it’s often viewed, at the very least, as the polite thing to do. More than this, it can help set the tone for a positive encounter.

As participants in the online forum pointed out, there can be several reasons why patients might be uncomfortable when physicians fail to observe the door-knocking etiquette.

If the patient is slow at disrobing and the doctor is punctual or even ahead of schedule, it can be awkward when the doctor barges into the room without asking, one person noted. This same person also observed, “A couple of times I’ve been really, really anxious and/or not feeling well, and sort of wanted a few seconds to compose myself.”

Other people said they knit, read, or talk on their cell phone while they wait. These folks might appreciate a five-second warning allowing them to end the conversation and put the diversions away.

One individual in the forum confessed to snooping around and playing with the blood pressure cuff and otoscope while waiting for the doctor to arrive.

Within the medical profession itself, most of the experts seem to agree: The doctor should knock on the door and (preferably) wait for the patient’s permission before coming in. Indeed, one of the many skills on which future physicians are evaluated is their ability to communicate with the patient, starting with that all-important first impression.

“Always knock before entering the examining room,” advises an online guide on preparing for the U.S. Medical Licensing Exam, or USMLE. “Knocking on the door before entering is the first step in building trust and showing respect.”

In an essay from 2008 in the New England Journal of Medicine, Dr. Michael Kahn takes this one step further by proposing “etiquette-based medicine” as a guideline for physician behavior. Training programs might not be able to successfully instill empathy and compassion in every medical student, but students can certainly learn how to behave well, he wrote.

A checklist Dr. Kahn suggests for a first meeting with a hospitalized patient starts with: “1. Ask permission to enter the room; wait for an answer.”

I think I’d feel a little silly giving the doctor permission to come in. After all, technically speaking it’s not my hospital room or exam room; I just happen to be a temporary occupant. And does it really matter whether the doctor barges in vs. waiting a second or two for a response?

On the other hand, most patients notice and appreciate the courtesy, small though it is. And they definitely notice when the doctor skips the door-knocking routine altogether – and this goes for staff as well as the physician. A scathing review on raked an Illinois doctor over the coals for, among other things, allowing two staff members to walk into the exam room without knocking first.

“How do you say ‘I don’t give a damn’?” wonders Kristin Baird of the Baird Group, a consulting firm whose expertise is in the patient experience.

Baird recently accompanied her sister, who had been undergoing cancer treatment, to a doctor visit. She writes: “The physician opened the exam-room door without knocking, stood with one hand on the door handle and the other on his hip as he coldly announced, ‘There’s nothing I can do for you. You need blood tests drawn, so go to the hospital.'”

There’s something to be learned from every experience, Baird says. “What did I learn today? I learned that there are many ways to say, ‘I don’t give a damn'” – starting with not bothering to knock on the door.

Photo: Wikimedia Commons

3 thoughts on “Knock, knock: exam-room etiquette

  1. If I’m naked, I’d like the wait (like a gyno appointment) to make sure no passers-by would catch a peek at something they shouldn’t, but otherwise, just come on in and lets get this over with.

  2. At a recent visit to my doctor: I was on the exam table with my groin area exposed. Had strained my groin at the swimming pool. Doctor Pena enters the exam room accompanied by another man! (Don’t know who the other man was)
    They both just stood there looking at my groin area! Dr. Pena did not do any hands-on inspection of my injured groin! I was snet home. Is this normal physician procedure?

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