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Interpersonal Skill in Medicine: The Essential Partner of Verbal Communication

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Abstract

Medical educators have promoted skillful communication as a means for doctors to develop positive relationships with their patients. In practice, communication tends to be defined primarily as what doctors say, with less attention to how, when, and to whom they say it. These latter elements of communication, which often carry the emotional content of the discourse, are usually referred to as interpersonal skills. Although recognized as important by some educators, interpersonal skills have received much less attention than task-oriented, verbal aspects. Moreover, the field lacks a common language and conceptualization for discussing them. This paper offers a framework for describing interpersonal skills and understanding their relationship to verbal communication and describes an interpersonal skill-set comprised of Understanding, Empathy, and Relational Versatility.

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References

  1. Association of American Medical Colleges. The Humanism in Medicine Award, Annual Meeting, 2006. Available at:http://www.aamc.org accessed Feb., 2006.

  2. Accreditation Council of Graduate Medical Education. ACGME Outcome Project. General Competencies. Available at http://www.acgme.org 2000. Accessed Nov., 2005.

  3. Makoul G, et al. Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Acad Med. 2001;76:390–3.

    PubMed  CAS  Google Scholar 

  4. Braddock CH, Edwards KA, Hasenberg NM, Laidly TL, Leveinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282(24):2313–20.

    PubMed  Google Scholar 

  5. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on patient outcomes. J Family Pract. 2000;49(9):796–804.

    CAS  Google Scholar 

  6. Street RL. Analyzing communication in medical consultations: do behavioral measures correspond to patients’ perceptions? Med Care. 1992;30(11):976–88.

    PubMed  Google Scholar 

  7. Engener B, Cole-Kelly K. Satisfying the patient, but failing the test. Acad Med. 2004;79(6):508–10.

    Google Scholar 

  8. Zoppi K, Epstein RM. Is communication a skill? Communication behaviors and being in relation. Fam Med. 2002;34(5):319–24.

    PubMed  Google Scholar 

  9. Roter DL. Observations on methodological and measurement challenges in the assessment of communication during medical exchanges. Patient Educ Couns. 2003:50(1):17–21.

    PubMed  Google Scholar 

  10. Makoul G. The SEGUE framework for teaching and assessing communication skills. Patient Educ Couns. 2001;45:23–34.

    PubMed  CAS  Google Scholar 

  11. Boon H, Stewart M. Patient–physician communication assessment instruments: 1986–1996 in review. Patient Educ Couns. 1998;35:161–76.

    PubMed  CAS  Google Scholar 

  12. Homboe ES, Hawkins RE. Methods for evaluating the clinical competence of residents in internal medicine: a review. Ann Intern Med. 1998;129:42–8.

    Google Scholar 

  13. Donnelly MB, Sloan D, Pymale M, Schwartz R. Assessment of residents’ interpersonal skills by faculty proctors and standardized patients: a psychometric analysis. Acad Med. 2000;75:S93–5.

    Article  PubMed  CAS  Google Scholar 

  14. Duffy FD, et al. Assessing competence in communication and inter-personal skills: the Kalamazoo II report. Acad Med. 2004;79(6):495–507.

    PubMed  Google Scholar 

  15. Webster’s Seventh International Dictionary. Springfield, MA: G. and C. Merriam Co, Publishers; 1998.

  16. Schachner DA, Shaver PR, Mikulincer M. Patterns of nonverbal behavior and sensitivity in the context of attachment relationships. J Nonverbal Behav. 2005;29(3):141–69.

    Google Scholar 

  17. Watzlawick P, Beavin JH, Jackson DD. Pragmatics of Human Communication. New York: Norton and Company, Inc; 1967.

    Google Scholar 

  18. Scheflen AE. The significance of posture in communication systems. Psychiatry. 1964;27:316–31.

    PubMed  CAS  Google Scholar 

  19. Birdwhistell RL. Kinesics and Context: Essays on Body Motion Communication. Philadelphia: University of Pennsylvania Press; 1970.

    Google Scholar 

  20. Gladwell M. Blink. New York: Little, Brown and Co; 2004.

    Google Scholar 

  21. Ambady N, Laplante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132:5–9.

    PubMed  Google Scholar 

  22. Coulehan JL, Block ML. The Medical Interview: Mastering the Skills for Clinical Practice. Philadelphia: FA Davis Co; 2006.

    Google Scholar 

  23. Goffman E. Behavior in Public Places. Glencoe, IL: The Free Press; 1963.

    Google Scholar 

  24. Hafferty FW, Franks R. The hidden curriculum; ethics teaching and the structure of medical education. Acad Med. 1994;69(11):861–71.

    PubMed  CAS  Google Scholar 

  25. Haidet P and Stein HF. The role of the student–teacher relationship in the formation of physicians: the hidden curriculum as process. J Gen Intern Med. 2006;21:S16–20.

    PubMed  Google Scholar 

  26. McLeod PJ, Tamblyn R, Benaroya S, Snell L. Faculty ratings of resident humanism predict satisfaction ratings in ambulatory medical clinics. J Gen Intern Med. 1994;9:321–6.

    PubMed  CAS  Google Scholar 

  27. Hornblow AR, Kidson MA, Jones KV. Measuring medical students’ empathy: a validation study. Med Educ. 1977;11:7–12.

    PubMed  CAS  Google Scholar 

  28. Winfield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34:90–4.

    Google Scholar 

  29. Dyche L, Zayas L. The value of curiosity and naivete for the cross-culture psychotherapist. Fam Proc 1995;35(4)389–99.

    Google Scholar 

  30. Fitzgerald FT. Curiosity. Ann Int Med. 1999;130(1):70–2.

    PubMed  CAS  Google Scholar 

  31. Borell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice and scientific inquiry. Arch Fam Med. 2004;2(6):576–82.

    Google Scholar 

  32. Barondess JA. Viewpoint: on wondering. Acad Med. 2005;80(1):62–5.

    PubMed  Google Scholar 

  33. Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75(4)269–76.

    PubMed  CAS  Google Scholar 

  34. Epstein RM. Mindful practice in action (II): cultivating habits of mind. Fam Syst Health. 2003;21(1):11–7.

    Google Scholar 

  35. Richardson R. Keat’s notebook. Lancet. 2001;357(25):320.

    PubMed  CAS  Google Scholar 

  36. Wear D, Nixon LL. Literary inquiry and professional development in medicine. Perspect Biol Med. 2002;45(1):104–24.

    PubMed  Google Scholar 

  37. Berger JT, Coulehan J, Belling C. Humor in the physician–patient encounter. Arch Intern Med. 2004;164(8):825–30.

    PubMed  Google Scholar 

  38. Charon R. Narrative medicine: a model for empathy, reflection and trust. JAMA. 2001;286(15):1897–1902.

    PubMed  CAS  Google Scholar 

  39. McCauly J, Yurk RA, Jenckes MW, Ford DE. Inside “pandora’s box:” abused womens’ experiences with clinicians and health services. J Gen Int Med. 1998;13(8):549–55.

    Google Scholar 

  40. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002:159:1563–69.

    PubMed  Google Scholar 

  41. Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559–64.

    PubMed  Google Scholar 

  42. Novack DH, Suchman AL, Clark W, et al. Calibrating the physician: personal awareness and effective medical care. JAMA. 1997;278(6):502–9.

    PubMed  CAS  Google Scholar 

  43. Macaskill A, Maltby J, Day L. Forgiveness of self and others and emotional empathy. J Soc Psychol. 2002;142(5):663–7.

    Article  PubMed  Google Scholar 

  44. Falicov CJ. Training to think culturally: a multidimensional comparative framework. Fam Proc. 1995;35(4):373–88.

    Google Scholar 

  45. Charon R. Medicine, the novel and the passage of time. Ann Int Med. 2000;132:63–8.

    PubMed  CAS  Google Scholar 

  46. Larsen EB, Yao X. Clinical empathy as emotional labor in the patient–physician relationship. JAMA. 2005;293(9):1100–6.

    Google Scholar 

  47. Borell-Carrio F. The depth of a smile. Medical Encounter. 2000;15:13–4.

    Google Scholar 

  48. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca, RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155(17):1877–84.

    PubMed  CAS  Google Scholar 

  49. Candib L. What doctors tell about themselves to patients: implications for intimacy and reciprocity in the relationship. Fam Med. 1987;19:23–30.

    PubMed  CAS  Google Scholar 

  50. Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287–90.

    PubMed  CAS  Google Scholar 

  51. Kiesler DJ, Auerbach SM. Optimal matches of patient preference for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006;61(3):319–41.

    PubMed  Google Scholar 

  52. Zinn WM. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med. 1990;113:293–8.

    PubMed  CAS  Google Scholar 

  53. Branch WT. Viewpoint: teaching respect for patients. Acad Med. 2006;81(5):463–7.

    PubMed  Google Scholar 

  54. Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self awareness, personal growth and well-being. Acad Med. 1999;74:516–20.

    PubMed  CAS  Google Scholar 

  55. Epstein RM. Mindful practice. JAMA. 1999;282(9):833–9.

    PubMed  CAS  Google Scholar 

  56. Beckman HB, Frankel RM. The use of videotape in internal medicine training. J Gen Intern Med. 1994;9:517–21.

    PubMed  CAS  Google Scholar 

  57. Edwards A, Tzelepis A, Melgar T, et al. Fifteen years of a videotape review program for internal medicine and medicine-pediatrics residents. Acad Med. 1996;71(7):744–8.

    PubMed  CAS  Google Scholar 

  58. Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ. 2005;37(2):145.

    Google Scholar 

  59. Schirmer JM, Mauksch L, Lang F, et al. Assessing communication competence: a review of current tools. Fam Med. 2005;37(3):184–92.

    PubMed  Google Scholar 

  60. Hodges B, Turnbull J, Cohen R, Bienenstock A, Norman G. Evaluating communication skills in the objective structured clinical examination format: reliability and generalizability. Med Educ. 1996;30:38–43.

    Article  PubMed  CAS  Google Scholar 

  61. Hanna M, Fins JJ. Viewpoint: power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81(3):265–70.

    PubMed  Google Scholar 

  62. Friedan RB, Goldman L, Cecil RR. Patient–physician concordance in problem identification in the primary care setting. Ann Intern Med. 1980;93:490–3.

    Google Scholar 

  63. Dyche L, Swiderski D. The effect of physician solicitation approaches on ability to identify patient concerns. J Gen Intern Med. 2005;20:267–70.

    PubMed  Google Scholar 

  64. Thom DH, Cambell B. Patient–physician trust: an exploratory study. J Fam Pract. 1997;44(2):169–76.

    PubMed  CAS  Google Scholar 

  65. DiMatteo MR, Hays R. The significance of patients’ perceptions of physician conduct: a study of patient satisfaction in a family practice center. J Community Health. 1980;6(1):18–34.

    PubMed  CAS  Google Scholar 

  66. Eisenthal S, Emory R, Lazare A. “Adherence” and the negotiated approach to patienthood. Arch Gen Psychiatry. 1979;36:393–8.

    PubMed  CAS  Google Scholar 

  67. Safran DG, Montgomery JE, Chang H, Murphy J, Rogers WH. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50(2):130–6.

    PubMed  CAS  Google Scholar 

  68. Levinson W, Rotor DL, Mullooly JP, Dull VT, Frankel RM. Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.

    PubMed  CAS  Google Scholar 

  69. Fiese BH, Sameroff AJ, Grotevant HD, et al. (eds.). The stories that families tell: narrative coherence, narrative interaction, and relationship beliefs. Monographs of the society for research in child development. Malden, MA: Blackwell Publishers; 1999:64(2 serial No. 257).

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Acknowledgments

The author would like to thank Kim Marvel, Mary Catherine Beach, Larry Mauksch, and Richard Frankel for their helpful comments on the manuscript.

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Correspondence to Lawrence Dyche ACSW.

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Dyche, L. Interpersonal Skill in Medicine: The Essential Partner of Verbal Communication. J GEN INTERN MED 22, 1035–1039 (2007). https://doi.org/10.1007/s11606-007-0153-0

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