Supporting effective doctor–patient communication: doctors’ name badges

Name badges are a simple additional method of communicating doctors’ names to patients and their families, but uptake remains poor

Most new relationships begin with an exchange of names and most existing relationships are reinforced using names. Except in health care. Despite campaigns such as #hellomynameis (https://www.hellomynameis.org.uk/), clinicians’ names remain absent from many health care experiences and environments. Patients meet many people during an illness journey, particularly when that takes place in a public hospital. There are nurses rotating through different shifts, the specialist under whom the patient is admitted, a registrar, resident or intern, plus maybe a medical student or two. There are also teams of allied health providers.

One study found that 75% of inpatients were unable to name anyone when asked to recall the name of the physician in charge of their care.1 Limited recall of doctors’ names is part of a broader pattern. Only 42% of patients can name their diagnosis at discharge,2 and in a study of older patients, only 18% of patients could recall a single message one hour after the ward round, falling to 9% four hours after the ward round.3

The very basic components of effective health care communication, particularly in hospitals, are lagging. Barriers to effective communication are complex and structural.4 Let's for a moment focus on the most fundamental information transfer in any patient–doctor encounter: names.

Patients’ names are documented from the moment of admission, printed on sticky labels, placed on wrist bands, attached to meal trays, printed on patient lists, and displayed and discussed in ward and team meetings. In contrast, doctors’ names usually appear only on faded ID swipe cards attached at the hip, or on crowded lanyards around the neck. This asymmetry in identification is just one symptom of the enormous information gulf separating patients and their doctors. Studies consistently show that the majority of patients believe doctors should wear name badges,5 with a preferred site being the breast pocket.6

In 2019, our hospital introduced voluntary name badges for all interns and residents. Something as simple as a name badge, which nearly every other service‐oriented industry employs without question, required careful navigation in the hospital. What name should appear on the badge? Should surnames be included? Should “Intern” or “Resident” or just “Doctor” appear on the badge?

Badges were rolled out to interns and residents at the start of the clinical year with a mixed response. Anecdotally, senior doctors commented favourably on the badges, and nurses and allied health workers found it helpful for learning and remembering the names of doctors rotating through their wards. Mid‐year, we collected data on how many interns and residents were wearing badges. During two compulsory teaching sessions, we quietly counted the number of interns and residents wearing name badges: adherence was a lowly 25%. To determine why three‐quarters of interns and residents were not wearing badges, we circulated a voluntary, anonymous and electronic survey to all 108 interns and residents. Our aim was to identify levers or incentives that we could incorporate into a series of behavioural nudges to improve name badge adherence.

Around one‐third (34%) of the cohort took part in the survey, 80% of whom did not wear their name badge. Half of respondents reported that their ID swipe card contained their name and was sufficient. About one‐fifth (22%) did not see a need to wear a name badge and a similar number mentioned that senior doctors not wearing badges discouraged them from wearing one. Not wanting members of the public or patients to know their name was a reason indicated by 16% of respondents. Free text responses mainly centred on forgetting to, or being annoyed by, attaching it each day.

In response, we have developed new strategies to increase name badge adherence. For example, a brief lecture will be given on the evidence‐base underpinning good communication, coffee vouchers will be provided to doctors seen wearing their badges, badges will be provided to new interns during orientation, and name badges will soon be rolled out across the hospital for all medical staff. Making name badges available to senior doctors is important as they can influence the cultures within units and teams, and our cohort identified a lack of badges among seniors as a barrier to adherence.

An informal poll of intern and resident representatives across New South Wales suggests a similar pattern of poor name badge adherence. Five networks with name badges reported that adoption by junior doctors was low. Four networks did not provide name badges. Only three networks provided name badges and have good adherence among junior doctors. As pressure on hospitals, and our clinical interactions, continues to grow, we must look for ways to support effective communication. Alongside a clear introduction, easy‐to‐read name badges reinforce familiarity and contribute to rapport between patients and our (increasingly) busy workforce.