Comportment and Communication Patterns among Hospitalist Physicians: Insight Gleaned Through Observation.
OBJECTIVE
By 2014, there were more than 40,000 hospitalists delivering the majority of inpatient care in US hospitals. No empiric research has characterized hospitalist comportment and communication patterns as they care for patients.


METHODS
The chiefs of hospital medicine at five different hospitals were asked to identify their best hospitalists. These hospitalists were watched during their routine clinical care of patients. An observation tool was developed that focused on elements believed to be associated with excellent comportment and communication. One observer watched the physicians, taking detailed quantitative and qualitative field notes.


RESULTS
A total of 26 hospitalists were shadowed. The mean age of the physicians was 38 years, and their average experience in hospital medicine was 6 years. The hospitalists were observed for a mean of 5 hours, during which time they saw an average of 7 patients (patient encounters observed N = 181). Physicians spent an average of 11 minutes with each patient. There was large variation in the extent to which desirable behaviors were performed. For example, most physicians (76%) started encounters with an open-ended question, and relatively few (30%) attempted to integrate nonmedical content into conversation with patients.


CONCLUSIONS
This study represents a first step in trying to characterize comportment and communication in hospital medicine. Because hospitalists spend only a small proportion of their clinical time in direct patient care, it is imperative that excellent comportment and communication are clearly defined and established as a goal for every encounter.
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Susrutha
S
Kotwal
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Haruka
H
Torok
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Waseem
W
Khaliq
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Regina
R
Landis
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Eric
E
Howell
From the Division of Hospital Medicine; Johns Hopkins Bayview Medical Center; Johns Hopkins University School of Medicine;and Baltimore, Maryland.
Scott
S
Wright
D000328:Adult; D003142:Communication; D005260:Female; D020445:Hospitalists / Q000523:psychology / Q000592:standards* / Q000639:trends; D006761:Hospitals; D006801:Humans; D008297:Male; D005791:Patient Care / Q000379:methods* / Q000592:standards; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D024382:Professional Role / Q000523:psychology; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States