R E V I E W A R T I C L E JIACM 2010; 11(3): 208-11

Doctor-Patient Communication:An Important but Often Ignored Aspect in Clinical Medicine

Ajay Kumar Shukla*, Veerendra Singh Yadav*, Nira Kastury**

Abstract

Communication is an important component of patient care. However, doctors are generally not given any specific training in howto communicate well with patients. Traditionally, communication in medical school curricula was incorporated informally as partof rounds and faculty feedback, but without a specific or intense focus on skills of communication per se. It has been shown thatgood doctor-patient communication has an impact on better health outcomes, higher compliance to therapeutic regimens inpatients, higher patient and clinician satisfaction, and a decrease in malpractice risk. It is the need of time to conduct more researchin this area and to actively include teaching the art of communication skills in undergraduate and postgraduate learningprogrammes for the benefit of both the doctor and the patient.

Key words: Compliance, medical malpractice, patient satisfaction, communication skills.

Having good communication skills is essential for

doctors to establish good doctor-patient relationship.

Until recently, the content, structure, and function of the

communication between doctors and patients has

received little attention and has been excluded from the

realm of scientific inquiry. As a result, most clinicians have

had little formal training in communication skills. With

the increase in demand from patients who value doctors

who are patient-centred (who spend time and listen to

them), together with the rise of consumerism in

medicine, health service research on doctor patient

relationship has become an important area of interest

for both medical researchers and administrators alike.

Not surprisingly, many undergraduate and postgraduate

medical education and training programmes have made

the attainment of good communication skills a core

requirement.

Why to emphasise on good doctor-patientcommunication?

Improved compliance with medical treatment

Low compliance with prescribed medical

interventions is an important problem in medical

practice and it is associated with substantial medical

cost including increased hospital admissions1. It also

creates an ongoing frustration to health-care

providers2. It has been shown that the doctor’s

attitude towards his patients, his ability to elicit and

respect the patients’ concerns, the provision of

appropriate information and the demonstration of

empathy and the development of patient trust are

the key determinants of good compliance with

medical treatments in patients3,4. Furthermore,

training doctors to improve their communication

skills could potentially be cost-effective as it

increases compliance, which in turn improves the

overall health of patients5.

Improved health, functional and emotional status

Good doctor-patient communication has been shown

to have a positive impact on a number of health

outcomes in previous studies. In a study that explored

the effects of communication skills training on the

process and outcome of care associated with patient’s

emotional distress, improvement in physicians’

communication skills was shown to be associated

with a reduction in emotional distress in patients6.

In a review of 21 randomised controlled trials and

analytic studies on the effects of physician-patient

communication on patient health outcomes, the

quality of communication in both history taking and

discussion of the management plan was found to

be associated with better health outcomes7. Better

doctor-patient communication was shown to be

* Resident, ** Professor and Head, Department of Pharmacology, Moti Lal Nehru Medical College, Allahabad - 211001,Uttar Pradesh.

associated with better emotional and physical

health, higher symptom resolution, and better

control of chronic diseases that included better

blood pressure, blood glucose, and pain control.

Moreover, in terms of reduction of utilisation of

health services, it was shown that patients who

perceived that their visits had been patient-centred,

received fewer diagnostic tests and referrals in the

subsequent months.

In a cross-sectional study looking at 2,881 patient

visits of 138 family doctors, physicians’ interaction

styles were categorised into 4 categories: person-

focussed, biopsychosocial, biomedical, and high

physician control by the use of a primary care

instrument8. They showed that physicians with a

person-focussed interaction style with patients were

associated with the highest reported quality of care

by patients, while physicians with the high control

styles were associated with the lowest reported

quality of care.

Improved clinician satisfaction

Although much emphasis has been put on the

importance of effective communication and good

doctor-patient relationship in affecting patient health

outcomes and satisfaction, physician satisfaction with

their professional life can also be an important

determinant of a good doctor-patient relationship. It

seems that physicians who are themselves more

satisfied may be better able to address a patient’s

concern9.

Reduces medical malpractice risk

In a study, conducted to examine factors that

prompted families to file malpractice claims against

doctors following perinatal injuries, it was shown that

communication was an important factor that was

related to these malpractice claims10. The same

authors also found that physicians who had been

sued frequently were also the ones who received

frequent complaints regarding the interpersonal care

that they provided for patients, even by patients that

never sued. The complaints from these patients

included “a feeling of being rushed”, “being neglected”

and a lack of explanations for tests performed.

Improved patient satisfaction

In a review of 17 studies by the Cochrane library that

was conducted to study the effects of interventions

directed at health-care providers to promote

patient-centred care, training health-care providers

in patient-centred approaches was shown to impact

positively on patient satisfaction with care11. It shows

that effective doctor-patient communication is

highly correlated with patient satisfaction with

health-care services.

What can be done to establish a betterdoctor-patient communication?

Scholars in doctor-patient communication discuss

different approaches that have been developed and used

as the basis for clinical training and research. It cannot be

claimed that any approach can be applied universally to

all societies because of transcultural differences.

However, certain general aspects can be identified in

doctor-patient communication for further improvement.

As physicians, we need to “listen with both ears,” that is,

symbolically assigning one ear to receive biomedical and

the other ear to receive psychosocial information. Often,

medical education places so much emphasis on the

biomedical aspect that student physicians tend to listen

only with a biomedical ear, and “judgments bearing on

social aspects of the patient’s life are commonly made with

minimum information about people, relationships, and

circumstances involved”12. Listening requires the

simultaneous intake of biomedical, psychological, and

social data. Priorities must then be set regarding both

assessment and management of these data. Goals should

follow the SMART principle, i.e., goals should be S (Specific),

M (Measurable), A (Achievable), R (Relevant) and T (Time-

related).

Transcultural awareness also plays an important role in

effective doctor-patient communication. Appropriateness

of eye contact, appropriateness of hand gestures, physical

contact between sexes (e.g., shaking hands), and cultural

beliefs surrounding the illness, are certain important

aspects in this regard.

The three-function model of the medical interview,

Journal, Indian Academy of Clinical Medicine Vol. 11, No. 3 July-September, 2010 209

210 Journal, Indian Academy of Clinical Medicine Vol. 11, No. 3 July-September, 2010

originally developed by Julian Bird for the purpose of

educating medical students13, represents a

comprehensive foundation for understanding doctor-

patient communication. The model highlights three core

functions of the interaction between the doctor and the

patient: gathering data to understand the patient,

development of rapport and responding to the patient’s

emotions; and patient education and behavioural

management. Each of the three functions carries high face

validity, as students and practitioners readily understand

and usually accept the importance of each of the three

functions.

Emerging Trends

New technology can dramatically change that

communication, from the invention of the telephone in

1876 to the more recent electronic mail (e-mail). These

technologies can revolutionise doctor and patient

contact, with potential benefits tempered by concerns

including privacy, security, and unwanted daily

intrusions14. Internet use is increasing dramatically and

e-mail can prove itself a potential tool in improving

doctor-patient communication15,16. A good number of

workers have reported improved satisfaction by both

patients and physicians in the e-mail group in their

studies17,18. In a survey of primary care physicians in

Boston, 75% of physicians reported using e-mail with

patients, but only with a small subset (5% or less) of their

overall patient population19. It reflects the need to

sensitise physicians to use modern technologies to

improve doctor-patient communication both in

developed as well as developing countries.

Another emerging trend is giving stress to build-up the

communication relations according to the needs of the

patients20. A study has shown that special communication

skills can improve health-care outcomes in people with

intellectual disability21. Different aspects of the doctor-

patient communication like patient’s perceptions22,

communication skills of the treating physician23, and

physician empathy24 are also getting more importance

both from physicians as well as research scholars.

Conclusion

Good doctor-patient communication is important and has

multiple impacts on various aspects of health outcomes.

The impacts included better health outcomes, higher

compliance to therapeutic regimens in patients, higher

patient and clinician satisfaction, and a decrease in

malpractice risk. Although medical education has only

recently started to emphasise the importance of

communication between doctor and patient, and started

to include the teaching of communication skills in many

undergraduate and postgraduate learning programmes,

it is still in its infancy in India. With the increase in

malpractice claims for doctors, together with the increase

in the volume of complaints and enquiries received by

the regulatory bodies, and a rise in consumerism in

medicine, good doctor-patient communication is

becoming even more important. Conducting research in

this area may help clinicians, educators, and health service

administrators to better understand the doctor-patient

relationship and doctor-patient communication that is

unique in our culture and social settings.

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