Review article
Patient–doctor communication

https://doi.org/10.1016/S0025-7125(03)00066-XGet rights and content

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Components of effective communication at an office visit

Surveys of patient satisfaction are more commonly being used by health insurance plans as one dimension for measuring the quality of care delivered. The failure of physicians to communicate adequately with their patients is a major reason patients may switch from one physician practice to another. Adequate communication encompasses a variety of components during an office visit from patient disclosures of medical and social information, to development of mutuality and comfort in the

Setting the tone and recognizing communication cues

The clinician is immediately faced with the opportunity to set the tone for an office visit on entering the examination room where the patient has been waiting, sometimes for lengthy periods of time. The patient's posture, demeanor, and activity at the moment the examination room door is opened should be carefully observed; it can be very telling of the mood and level of concern of the patient. Even before the first verbal exchange, observations of nonverbal behaviors (eg, gestures, agitation,

Structured patient interview model

How well the patient interview is conducted during an office visit can vary greatly, as can the yield of information. Time frames for office visits are very compressed so time must be used judiciously. A critical skill to develop as a clinician is to gather sufficient information methodically in a caring way, not making the patient interaction seem rushed or incomplete. The art of medicine is intricately tied to the art of communication; examples abound of missing pieces of personal and medical

Gender and cultural differences in communication

Clinicians need to adapt communication approaches to various settings. Communications between genders and between cultures (eg, the patient's culture and the medical culture) represent examples of potential communication barriers that deserve attention.

Dimensions of patient–doctor communication in different clinical settings

Patient needs and communication challenges vary greatly in different clinical settings. Selected examples of adapting communication techniques to specific clinical settings include:

  • Counseling patients about physical activity to incorporate behavioral changes around exercise habits and lifestyle factors

  • Discussing with patients about pain in different body systems as influenced by patient bias and preconceived ideas

  • Assessing multiple dimensions of the care of patients with terminal illness

Tools to aid patient–doctor communication

To accomplish the complex goals for so many different patient types and such varied diseases in the compressed time frames of the typical office visit is a challenge. It calls on the clinician to innovate from the traditional teachings to maximize communication effectiveness with the patient.

Keeping face-to-face communication and hands-on care as an indispensable core value, clinicians also need to use selected communication tools, including publicly developed resources on disease education

Summary

Communication is an important component of patient care. Traditionally, communication in medical school curricula was incorporated informally as part of rounds and faculty feedback, but without a specific or intense focus on skills of communicating per se. The reliability and consistency of this teaching method left gaps, which are currently getting increased attention from medical schools and accreditation organizations. There is also increased interest in researching patient–doctor

Acknowledgements

The author gratefully acknowledges expert assistance with editing this manuscript from Dr. Lisa Truong. She also thanks Barbara Seely for her valuable support with information retrieval.

Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs. Sir William Osler

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