Communication Skills and Doctor–Patient Relationship

Good communication skills are extremely important for doctors. They help in creating an interpersonal relationship and facilitate the exchange of information, thus helping in establishing the correct diagnosis. Good communication skills also help in counseling the patients and giving therapeutic instructions.

Doctors may or may not be possessing excellent communications skills. However, they can learn and practice good communication.

Components of Communication

Verbal Opens in new window, nonverbal Opens in new window, and paraverbal Opens in new window are the three basic components of effective communication.

1. The verbal component includes content and selection of the words.
2. The paraverbal component includes tone, pitch, pacing, and volume of the voice.
3. The nonverbal component includes body language (e.g., posture, gesture, facial expression, and spatial distance).

Verbal component (content) conveys information about the various aspects of the disease, for example, nature, course, prognosis of the disease, and various treatment options available, etc.

Nonverbal component significantly influences important outcomes like patient’s satisfaction, adherence to advice, and clinical outcome.

Paraverbal communication adds more meaning to the words. Even if one has the right words, how s/he delivers them can change the impact of the verbal component.

Appropriate use of the paraverbal component helps in making the desired impact.

Attentive listening skills Opens in new window, empathy Opens in new window, and use of open-ended questions are some examples of skillful communication. Some of the characteristics of good communication are as follows:

• Maintaining eye contact: Eye contact is considered an important component of effective communication. Maintaining eye contact doesn’t mean staring at the person.
• Being attentive: Attentive means ignoring external distractions like background activity and noise as well as internal distractions like one’s own thoughts or feelings.

• Show interest in what the patient is saying with your mannerism (e.g., head nodding), body language, and active involvement (e.g., learning toward the patient).
• Mannerism like patting patient’s shoulder may convince the patient that you care for them.
• Don’t interrupt the patient and wait for him/her to complete the conversation.
• Pay attention to both verbal and non-verbal components of the communication of the patient and observe if there is any discrepancy between the two.
• The doctor should be aware of his/her nonverbal clues like body language and gestures.
• Never have discussions with patients or relatives while walking in the corridors.

Different Models of Communication

Several models of communication have been used during clinical consultations. These include:

1. BIHC Communication E4 Model
2. Three Function Model
3. The Calgary–Cambridge Observation Guide
4. Patient–centered clinical method, and
5. SEGUE Framework for Teaching and Assessing Communication Skills.

A group of representatives developed a consensus model of the five models mentioned earlier describing the essential step in clinical consultation. This model is called the Kalamazoo Consensus Statement, which identifies seven essential sets of communication tasks.

1. Building the Doctor-Patient Relationship

A strong, therapeutic and effective relationship is the sine qua non of physician–patient communication.

2. Opening the Discussion

This involves allowing the patient to complete his or her opening statement and eliciting the patient’s full set of concerns and establishing a personal connection.

3. Gathering Information

This includes using open-ended and closed-ended questions appropriately and by active listening using nonverbal (e.g., eye contact) and verbal (e.g., words of encouragement) communication followed by structuring, clarifying, and summarizing information.

4. Understanding the Patient’s Perspective

This includes exploring contextual factors (e.g., family, culture, gender, age, socio economic status, and spirituality), beliefs, concerns, expectations about health and illness, and acknowledging and responding to the patient’s ideas, feelings, and values.

5. Sharing the Information

It includes using the language the patient can understand, checking for understanding, and encouraging the patients to ask questions.

6. Reaching Agreement on Problems and Plans

This can be achieved by encouraging the patient to participate in decisions to the extent s/he desires and by checking the patient’s willingness and ability to follow the plan.

7. Providing Closure

This is concerned with asking whether the patient has any other issues or concerns. At the end summarize and discuss the follow-up (e.g., next visit, plan for unexpected outcomes).

Training in Communication Skills

Teaching communication skills requires educators who themselves are excellent communicators. A communication skills training (CST) program should be:

• multi-session and multi-disciplinary;
• should use multiple methods; and
• include opportunities for demonstration, discussion, reflection, practice, and feedback.

Experiential methods supplemented with feedback (e.g., role-plays or interaction with stimulated or real patients) are more effective than instructional methods (e.g., lectures and seminars).

Experiential methods help students in identifying their strengths and weaknesses in communication and are preferred by students. Closed-circuit television (CCTV) video-recording can be used to provide feedback to trainees during CST.

In a role-play, a student performs a given role and the facilitator and peers give feedback after the session. To be effective, educators utilizing role-play should provide feedback in a way which does not make the learner anxious. Students reflect and learn the significance of voice, tone, or body language Opens in new window through role-plays.

Training in verbal and nonverbal communication goes hand-in-hand. Students also learn by observing clinicians working in a clinical setting in addition to learning during training session. The faculty members should be sensitized that they are the role models and are knowingly or unknowingly imparting training in communication skills while providing clinical care.

Communication skills should be assessed in examination settings throughout the medical curriculum.