Author Affiliations: Division of Hospital Internal Medicine (Drs Maniaci and Dawson) and the Biostatistics Unit (Mr Heckman), Mayo Clinic, Jacksonville, Florida.
One aspect of improving patient safety and satisfaction in the hospital is the patient's ability to communicate with his or her principal caregiver. The first step in this communication chain is identification of the primary attending physician. Unfortunately, in many teaching institutions this can be difficult for a patient. Patient care at many teaching institutions includes multiple health care providers, such as the primary attending physician, resident physicians, consulting physicians, and fellows. With such a multitude of house staff interacting with the patient on a daily basis, it is common for patients to experience confusion when trying to identify their primary attending physician. Physicians contribute to this problem by not introducing themselves properly.1 Nonteaching hospitals can have similar difficulties owing to the rise of the use of hospitalists who assume inpatient care from the patients' regular primary care physicians.2
A recent article in the Archives reported that only 281 of 2807 patients (10%) were able to correctly identify any inpatient physician in charge of their care.3 To see if we could improve this problem, we conducted a study to see if constant visual representation of the physician's name increases the patient's ability to correctly identify his or her primary attending physician.
We prospectively studied 150 patients hospitalized within the Internal Medicine Teaching Service; 50 patients were placed in rooms without a dry erase board and 100 with a dry erase board on which the attending physician's name was to be displayed daily. Patients were assigned to rooms by the normal central administration routine, without knowledge of which rooms were equipped with the boards. Patients in both groups were informed of their attending physician's name and met all of the physicians on their care team within the first 24 hours of hospitalization. Patients in the rooms with dry erase boards were informed once on admission by the nurse that their attending physician's name, nurse's name, and hospital service were displayed on these boards in their rooms. Patients with moderate to severe dementia or any uncorrected visual problems were excluded from the study.
Twenty-four hours after admission to the floor, the patients in each study group were asked the identical question: “Using any means at your disposal, can you name your attending physician?” In addition to patient responses, the accuracy and completeness of the dry erase board information was recorded. Of the 100 patients with a dry erase board in their room, the name of the attending physician was not displayed on the board for 4 patients, and these 4 patients were excluded from the study. Thus, a total 146 patients were studied, of whom 50 had no dry erase board in the room and 96 had a dry erase board in their room on which the attending physician's name was displayed.
The proportion of patients who were correctly able to identify the name of their coordinating attention physician was recorded separately in patients with and without visual representation of the attending physician's name on a dry erase board in the room. Exact binomial 95% confidence intervals (CIs) were calculated for these proportions. The difference between these 2 proportions was also estimated, along with the 95% CI, and the 2 proportions were compared using the Fisher exact test, for which P ≤ .05 was considered statistically significant. Statistical analyses were performed using S-Plus software (version 8.0.1; Insightful Corporation, Seattle, Washington).
Age, ethnicity, length of hospital stay, presence of corrected cataracts, and presence of mild dementia or memory loss was similar between the 2 groups of patients, with and without visual representation of the attending physician's name on a dry erase board in their room (Table). However, the proportion of men was noticeably higher in patients with visual representation of the attending physician's name (60% vs 36%).
Of the 50 patients without visual representation of their attending physician's name on a dry erase board, only 5 (10%; 95% CI, 3%-22%) were able to correctly identify the name of their attending physician. There was very strong evidence that this proportion was higher for patients with visual representation of their attending physician's name (P < .001), of whom 94 of 96 patients (98%; 95% CI, 93%-100%) were able to correctly identify their attending physician's name. This indicates that compared with patients with no visual representation, the proportion of patients who were correctly able to identify the name of their attending physician was 88% higher (95% CI, 76%-94%) for patients with visual representation of their attending physician's name in their room. Of note, of the 4 excluded patients for whom the attending physician's name was not written on the dry erase board, none were able to correctly identify the name of that physician.
Our results confirm that patient knowledge of their attending physician is poor, since only 10% of our control group was able to identify the name of their attending physician correctly. This is consistent with previous findings.3 With a simple modification of having the name reliably visualized in front of them, we improved this knowledge in virtually all patients interviewed (98%). Although this may have been expected, as the name was written for patient reference, previous studies have found that repeated visualization of medical information improved recall significantly even after the information was no longer visualized.4 One limitation of our study is that although the patients showed improved name recognition, we are unsure if this process would improve face recognition. Francis et al5 found that the use of photographs helped patients identify hospital team members, and this led to higher overall patient satisfaction. A similar study using physician photographs posted on a patient room display would be an interesting next step.
On the basis on our findings, we conclude that a simple system that includes visual representation of all of the health care team's names and responsibilities can help improve the awareness of patients' identification of their medical providers.
Correspondence: Dr Maniaci, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (email@example.com).
Author Contributions:Study concept and design: Maniaci. Acquisition of data: Maniaci. Analysis and interpretation of data: Maniaci, Heckman, and Dawson. Drafting of the manuscript: Maniaci, Heckman, and Dawson. Critical revision of the manuscript for important intellectual content: Maniaci and Dawson. Statistical analysis: Heckman. Administrative, technical, and material support: Maniaci. Study supervision: Dawson.
Financial Disclosure: None reported.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 28
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.