Medicine, Australian-style: Patients, Physicians as �Mates�

By Howard Amiel, M.D.

I�m learning that less formality can improve patient care. In Australia, where I currently practice, the patient-physician relationship is far less formal than what I�ve been accustomed to back home in the United States.
As a general rule, patients address their physician by first name and do not think it inconsiderate to omit the title or last name altogether. It took some time to become accustomed to greeting my patients with �Hi, I�m Howard,� mostly because an introduction like that could easily be finished off with something like �� can I take your order?� Of course, the context of the encounter makes it obvious, but the sound of it made me feel somewhat awkward. It all seemed a bit chummy to suddenly be on a first-name basis with my patients, but eventually I caught on. Today, I don�t think anything of it when the majority of my male patients bellow out a genuine �Thanks, mate!�

Doctors, Patients More at Ease
For better or worse, this often gracious and more egalitarian type of relationship also encourages the occasional curious patient to attempt to spark up a conversation of a more personal nature.
Some of my patients are quite affable and chatty, and they seem to possess interviewing skills to rival those of Katie Couric or Barbara Walters. Generally, the questions are tactful and never inappropriate, with the simple intention of becoming better acquainted with their new, young doctor. For some reason, a common question has been �Are you a Canadian?� It�s an unlikely query, given there are approximately eight or nine times more Americans than Canadians. Perhaps there are more of our similarly accented cousins in a fellow commonwealth country like Australia; after all, only 20% of adults in the United States have a passport.
Whatever the reason, I find the prospect of offending Canadians by mistaking them for Americans interesting. Perhaps Canadians are fed up with being mistaken for the other, more outspoken and conspicuous North American. Are they plagued by a sort of �Jan Brady� syndrome, begrudgingly and forever in the shadow of the more well-known sibling? But I do recognize and appreciate my Australian patients� kindness, consideration and mindfulness to not presume every North American they meet is from the United States.

The dress is also a little less formal here. If not for the tie, there isn�t much to distinguish a young doctor like myself from other hospital employees. On weekends, when I often scrap the tie, I could pass for just about any hospital employee with a badge fastened to his shirt pocket.

Back home, the lab coat is the doctor�s de facto uniform. In Australia, it is seemingly nonexistent. I was quite proud that I had managed to squeeze two gleaming white lab coats into my overstuffed, just barely underweight luggage. It wasn�t until I arrived that I was notified that I wouldn�t be rotating through the laboratory or the cosmetic counter at the local department store, and therefore a lab coat wouldn�t be necessary. How silly of me. In truth, the absence of the lab coat seems to make the relationship more equitable, and in turn, I sense my patients are more at ease.

Better Communications
Improve Job Quality
When the doctor-patient relationship is freed from the traditional constraints of assigning the authoritative role to the physician while relegating a submissive role to the patient, we are offered the opportunity to get to know each other on a different level. I feel that this less formal, more even-handed relationship not only improves our rapport with our patients, but also makes the job much more enjoyable. OM

Howard Amiel, M.D., began writing for Ophthalmology Management as a fellow at Koch Eye in Warwick, R.I., and concludes his participation in �New M.D.� as a fellow at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. With this installment, Dr. Amiel concludes 1 year of sharing his experiences as a newly minted ophthalmologist. His e-mail is howard_amiel@brown.edu. �New M.D.� will return with new contributors in the March issue of Ophthalmology Management.