Throughout patient-centred communication literature, including patient satisfaction surveys (such as the NSW Health Patient Survey 2008), patients consistently stated that when clinicians introduced themselves and explained their role, it helped alleviate their anxieties. One of the recommendations of the Garling Inquiry (Garling 2008) was that clinicians wear name and position badges at all times. Apart from needing to feel reassured in what can be a bewildering context, patients also need to know who is questioning them and to what end, if they are to cooperate fully with the process. Our data showed that while clinicians regularly introduce themselves to patients, they frequently do not specify their status or their role in the emergency department.

Patients have encounters with many people, not all of them clinicians, during their stay in the emergency department. For example, one patient we recorded, Nola, had 172 different encounters during the time that she was in the emergency department. This meant that every 29 secs either she engaged with someone or the consultation was interrupted. Add to this the fact that Nola was an elderly patient who was in pain, and the potential for confusion is increased.

In Nola’s initial medical consultation , the junior doctor did not introduce herself. The nurse (N2), who was doing her ‘obs’, announced the doctor’s arrival (N2 ‘The doctor’ll ask you questions now’) but Nola did not register the information and thought the junior doctor was ‘a nurse’. This assumption may well have affected the kind of information that Nola provided. After responding to many questions about her medical history Nola finally expressed her confusion by asking the doctor:

At the conclusion of the initial medical consultation, the junior doctor announced that she was waiting on the results of tests and would return in due course. Again Nola tried to connect with the identity of the junior doctor:

By contrast, in another emergency department, Jack (feeling unwell, weak), was in a wheelchair and in the advanced stages of multiple sclerosis . He had arrived at 9 am and was first seen by the doctor at 1.05 pm. The junior doctor, who must have known that Jack had had a long wait, was particularly welcoming to the patient:

Below are examples of how other doctors and nurses introduce themselves:

One of the doctors in the ‘fast track’ section of one emergency department was particularly welcoming to a young patient who had severely lacerated his thumb and who was in great pain. The senior doctor was mentoring a young student doctor throughout the consultation and greeted the patient:

In another emergency department, Ghadir (back pain) was anxious to know the level of experience of the doctor who had attended to her. She had just been told that the medication she would be on would not interfere with her breast milk and felt uncertain about this and about her diagnosis . Ghadir’s husband also commented on the couple’s ignorance about the junior doctor’s experience and status and how this would affect their trust of the diagnosis and treatment:

As the above interchange between the researcher and Ghadir’s husband illustrates, a clinician’s failure to introduce themselves or their role can jeopardise the establishment of trust and confidence between clinicians and patients. This may lead to lack of agreement in terms of treatment plans and potentially noncompliance with recommended treatment.

When clinicians use inclusive language , they help put patients at ease in the interaction and create an environment where the patient feels more included in making decisions. Effective inclusive language techniques include using the patient’s first name and using the inclusive pronoun ‘we’ to include the patient in the actions and decisions of the clinical staff. Using the patient’s first name allows patients to feel personally identified in what can be a very intimidating environment. In the following example, one clinician addresses Mara (blockage of oesophagus) by her first name:

With Wilson (sore toe) the nurse focused very specifically on the patient’s statements about how long he had waited to get into the emergency department and encouraged him by saying it had not in fact been all that long given the current deteriorating situation. She used his name and positive feedback to try to soften the blow of his long waiting time:

The use of first names has the effect of putting the patient at ease in the interaction and helps create an environment where the patient feels more included in the process. Some clinicians, more typically nurses, use terms of endearment as a way of making patients feel included, although these may be interpreted as patronising, particularly when used with elderly patients . The nurse with Nola (PR bleeding), tried to encourage her to co-operate in this way:

Other examples from our data included:

The inclusive pronoun ‘we’ can be used to co-opt the patient into the healthcare team. With Graydon (cardiology admission), the nurses emphasised the team nature of their work, by alternating their turns in the talk, by using ‘we’, and by explaining what the other person was about to do. In this way, the nursing staff succeeded in recruiting Graydon as a team participant, while emphasising the patient’s role as an active agent in the consultation:

Clinicians also used ‘we’ when referring to the medical procedures that would take place in the emergency department. This reinforced the fact that the medical care that Donna (anal fissure) , was receiving was a team effort. Nurses admitting patients frequently work in pairs and in the example below, nurse 2 and nurse 3 were settling Donna and changing her into her gown. Nurse 2 goes back and forth between offering her assistance both personally and institutionally (collectively):

The use of ‘we’ draws in the patient as an active agent in the consultation, juxtaposed with the use of ‘I’ when the doctor’s professional expertise is foregrounded. We see this with Luca (stiff neck):

When presenting or requesting medical information, most clinicians are careful to recast their technical terms in more everyday and sometimes quite colloquial terms, so that their patients can understand what they are saying:

The use of these everyday words not only ensures comprehension but also helps to put patients at ease in what is in reality a very formal and unfamiliar context. The registrar with David (sore testes) uses the same technique: