The term "patient-physician communication" encompasses a wide range
of interactions. These range from physicians' conversational style to formal
techniques for coping with patients' concerns. It has become clear that the
quality and content of patient-physician interaction has important effects
on both participants. For example, good communication with patients can be
associated with improved treatment adherence,1 and
physician communication styles appear to be associated with the risk of malpractice
litigation.2 Although the actions that constitute
good communication with patients are still vaguely defined in the literature,
there has been a great deal of recent interest in refining methods to promote
better communication between physicians and patients. This issue of MSJAMA approaches patient-physician communication from
several different perspectives, reflecting both the breadth of the field and
its relevance to clinical practice.
Gregory Makoul summarizes recent developments in attempts to measure
medical students' communication skills in an objective way. The proposal to
include a clinical skills assessment as part of the United States Medical
Licensing Examination (USMLE) is the first nationwide attempt to standardize
and assess the clinical communication skills expected of medical graduates.
The remaining articles discuss communication aspects in medical practice.
Kiran and Pavi Kundhal address the growing need for physicians to understand
how culture affects patients' experience of illness. Two other articles address
specific clinical situations that, while common in medical practice, are frequently
difficult for clinicians to address effectively. Rebecca Gordon-Lubitz discusses
issues regarding the communication of risk and risk assessment to patients.
Statistical analyses and risk stratification for various treatment options
is complicated information and can confuse patients trying to make decisions
in the setting of illness and uncertainty. Gordon-Lubitz addresses some of
these difficulties and outlines strategies that can be used to improve understanding.
Similarly, Michael Hahn addresses ways in which physicians communicate with
patients about advance directives. He notes some specific problems with advance
directives as they are currently employed and describes approaches that may
increase the use and efficacy of advanced directives.
The goal of research in patient-physician communication is to find approaches
to help physicians interact with patients in ways that will be beneficial
for both parties, and these articles represent only a small sample of this
growing field. The best methods for promoting good communication with patients
are still being refined. The question of how to teach physicians to use these
approaches successfully is similarly unclear. However, the need for clear
and effective interactions with patients makes patient-physician communication
an issue of considerable clinical importance.
Ihler E. Patient-Physician Communication. JAMA. 2003;289(1):92. doi:10.1001/jama.289.1.92-a