Physician Barry Silverman took the long view of medical professional etiquette in an article titled Physician behavior and bedside manners: the influence of William Osler and The Johns Hopkins School of Medicine. Pointing out that ‘the accomplished doctor has a bedside manner that is humane and compassionate, empathetic and supportive‘, he criticised the Oslerian approach to bedside manner and drew his lessons on professional etiquette from the historical traditions of medicine. He particularly pointed to the Hippocratic oath which outlines several principles of physician etiquette as it relates to the patient. These recommend that the physician should:

• • Have an ‘appearance and approach that is distinguished‘
  • Be ‘solicitous‘ in approaching the patient, ‘with head inclined slightly as the art demands’
  • ‘Hold his head humbly and evenly’
  • ‘Approach the patient with moderate steps, not noisily’
  • Gaze ‘calmly at the sick bed’
  • ‘Endure peacefully the insults of the patients since those suffering from melancholic or frenetic ailments are likely to hurl evil words at physicians’

Professional etiquette starts the very first time the physician meets the patient, and this first contact was explored by physician Lloyd Kitchens in an article titled Viewpoint: Medical etiquette. After emphasising the importance of appropriate dressing and demeanour, he said ‘it is proper to introduce yourself to the patient, remembering that even in private settings the patient may not know who you are’. He then discussed how the physician should address the patient stressing that ‘how one addresses a patient is critically important and can either make or break the doctor-patient relationship at its very inception‘. He recommended that ‘patients should invariably be addressed by the doctor as “sir” or “ma’am,” or “Mr.” or “Ms.”, cautioning that ‘early use of first names prior to being asked…is highly inappropriate’. He went on to add that the physician should ‘keep the interaction formal, unless and until the ground rules are changed by the patient’.

In a broader view of professional etiquette, etiquette consultants Marisa Torrieri and Aubrey Westgate viewed medical etiquette through the universal principles of old-fashioned good manners. In this regard, Torrieri and Westgate made the following helpful recommendations: