Most people want doctors to shake their hand and be greeted by first name when they first meet but the expectation is not always met, a new study suggests.

"The first few moments of a medical encounter are critical to establishing rapport, making the patient feel comfortable and setting the tone of the interview," Gregory Makoul and colleagues at Northwestern University's school of medicine in Chicago wrote in Monday's issue of the Archives of Internal Medicine.

Physicians and medical students are encouraged to shake hands, address the patient by name and introduce themselves, but there is little evidence on what type of greeting — first name, last name or both — is appropriate.

To find out, Makoul and his colleagues surveyed 415 adults in the U.S. between 2004 and 2005 to learn what patients expect and prefer, and then analyzed videotapes of 123 new patient visits to doctor's office to see what actually happens.

Of the patients surveyed:

• 78.1 per cent wanted physicians to shake their hand, while 18.1 per cent did not.
• 50.4 per cent wanted to be greeted with their first name, 17.3 per cent preferred
  their last name and 23.6 per cent favoured the doctor using both first and last names.
• 56.4 per cent wanted physicians to introduce themselves using first and last names, 32.5 per cent expected physicians to use their last name, and 7.2 per cent would like physicians to use their first name only.

The videotapes showed handshakes 82.9 per cent of the time. In 62 visits — 50.4 per cent — doctors did not mention patients' names at all; in 48 cases — 39 per cent —patients' names were not mentioned by either party.

First, last names for respect  

Doctors used their first and last names when introducing themselves 58.5 per cent of the time, and did not introduce themselves at all in 14 visits, or 11.4 per cent of cases.

"Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behaviour," the study's authors concluded.

"Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names."

The survey responses reinforced the importance of doctors introducing using their first and last names. For example, if Dr. Robert Franklin meets Jane Smith, he could say: "Jane Smith? Hi, I'm Bob Franklin."

Parallel strategy

Using this parallel strategy communicates respect and reciprocity, and the videotaped sample showed it was the form physicians were most comfortable with, the study's authors said.

In a previous study, patients often complained that the doctor did not introduce himself, or they were not sure whom they were seeing or what the physician's role was, such as a medical student or specialist.

"In sum, greetings create a first impression that may extend far beyond what is conventionally seen as 'bedside manner,'" the study said.

As for shaking hands, older patients were somewhat less likely to say they preferred the practice, the surveyed suggested.

"Of course, physicians should maintain safety and hygiene by washing their hands," the researchers said.