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The other E&M guidelines: etiquette and manners

Practice Management. By Pamela Lewis Dolan, amednews staff. Dec. 25, 2006.

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Everything cosmetic surgeon Amiya Prasad, MD, has learned about manners in the business world has come through experience.

"When you go to med school, you are not being exposed to that aspect," said Dr. Prasad, medical director of Le Visage, a cosmetic and implant dentistry practice in New York. "You don't learn business or networking or those other important aspects to being a doctor, so certainly that can put you at somewhat of a disadvantage."

A growing number of etiquette experts are trying to fill this gap. Just as physicians can hire consultants to handle their financial and technology questions, they can now hire etiquette consultants who can teach skills from knowing when to talk shop -- and when not to -- to knowing which fork is for the salad. Etiquette experts usually charge $1,000 or more to lead half-day or full-day sessions. However, the experts will see physicians in groups, so a doctor could invite others along to divide that cost.

People expect physicians to be refined, said Kathleen Pagana, PhD, RN, an independent etiquette consultant from Williamsport, Pa. How a physician practices the social graces can reflect upon his or her practice, she said.

"When people see a refined physician, they can only assume their practice is refined." Dr. Pagana said. "But if you're a slob when you're eating, they think you're a slob in the office."

Kate Zabriskie, founder of Port Tobacco, Md.-based Business Training Works Inc., which trains physicians and corporations on so-called "soft skills" such as etiquette and public speaking, said physicians are uncomfortable asking for help with something as basic as etiquette. And even though most know better than to talk loudly on a cell phone at the dinner table or berate the wait staff, many are making mistakes they are not even aware of, she said.

Experts say physicians, like many in other professions, tend to make their social faux pas in one of two ways -- a slip during a dinner or cocktail hour, or botching small talk.

Dr. Pagana said dining and cocktail parties are a time when the most eyes are on every move the physician makes. She said she's taught many physicians these easy tips that can make a big difference:

• Don't show up hungry. This is bad for two reasons, Dr. Pagana said. First, this can cause you to hover over the buffet table and neglect to socialize. Second, it causes a circus act to ensue while the wine glass is being juggled with the food plate. Dr. Pagana recommends grabbing a quick bite as soon as you arrive, or eat ahead of time.
• Hold your drink glass in the correct hand -- your left. It's a small thing no one will notice -- until they shake your hand, cold and wet from condensation from the glass, said Dr. Pagana.
• Use mnemonic devices to negotiate the dinner area. Because most large functions are set up with round tables, Dr. Pagana likes to use the BMW (bread, meal, water) rule as a way to remember the bread is on the left, meal is center, water and other drinks to the right. She also has a left, right method for remembering silverware placement. Right has five letters, as do knife and spoon, so that's where they go. Fork has four letters and it goes to the left, which also has four letters. And if you don't know one fork from another, go from the outside and work in and you can't go wrong, she said.
• Serve others before yourself. If there's one thing to remember about serving, she says, it's to not serve yourself first, even if the platter is in front of you. There are two options: You can either serve the person to the right, then serve yourself as you pass to the left (clockwise), or just start out by passing left.
• A soiled napkin needs to be hidden. Because physicians are commonly paged or called away from dinners, often they struggle with what to do with their napkin when they excuse themselves, Dr. Pagana said. A good rule of thumb, and easy way to remember, is that no one wants to see the ketchup you wiped from your mouth, so place the napkin in the seat of the chair.

Shop talk

Then there's the dinner conversation. Zabriskie said physicians often make the mistake of talking shop in social settings where they are surrounded by nonphysicians. Zabriskie said she once was personally grossed out at a dinner party at which an emergency physician described in graphic detail a recent trauma case.

Zabriskie recommends doctors pick up an issue of USA Today before an event. It's a quick read that can give the doctor something to talk about other than work, she said. She also advises physicians to listen for clues that people aren't interested in what they are saying. Her favorite subtle hint to get a physician to stop talking shop is to ask if they ever get much time off work and what they do when they aren't treating patients. If people are interested in hearing more about work, they will ask specific questions about it, she said.

Dr. Prasad said he and his wife, Sudha, a pediatrician, make a point of not talking shop at social events.

Drawing from his experience, Dr. Prasad says physicians don't necessarily need an etiquette expert to learn what to do. Instead, they need to draw on the personality traits, such as being friendly and caring, that drew them to medicine. He said listening to others is a part of being a doctor that can play out well in social situations.

"If you are comfortable with yourself and other people, you can adapt" and talk about other things, he said.

Dolan is a business reporter. She can be reached at 312-464-5412 or by e-mail (pamela.dolan@ama-assn.org).

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