Communicating with Patients

Abstract

The goal of the doctor–patient encounter is to exchange health-related information and counsel the patient. This section describes the different models of the doctor–patient relationship and the difficulties students face in learning how to talk to patients. It also suggests ways to deal with barriers in doctor–patient communication and patients’ noncompliance with medical advice.

The main learning difficulties students seemed to have in acquiring interviewing skills were the inconsistency between the patient-centered approach advocated in preclinical teaching programs and the disease-centered approach practiced on the wards. Other students were confused by the ambiguous vocabulary and multitude of rules for interviewing. Still others seemed annoyed by attempts to teach them what they thought was elementary courtesy and resented counterintuitive interview rules.

To overcome these difficulties, I propose a teaching approach based on the premise that students learn more effectively when they are autonomous than when they respond to the instructions of others. Rather than being lectured, students are asked to identify the problems in doctor–patient communication and propose solutions. They watch live demonstrations of patient-centered and disease-centered interviews and discuss the pros and cons of each. This approach supports students in identifying and solving problems in patient interviewing and in choosing a balance between patient-centered and disease-centered interviewing styles.

Learning patient interviewing is different from learning other clinical skills. Students are not naïve about the skill to be learned; they encounter role models with very different interviewing styles; most clinical instructors are not specialists in interviewing, and the validity of interviewing assessment methods is uncertain. Therefore, I suggest that instructors should first gain insight into students’ views and use those views as a starting point for discussions about how to talk to patients; second, help students understand why different clinicians use different communication styles; third, receive additional training to enable them to act as both specialists and facilitators of small group learning; and finally, use assessment methods that promote reflection among learners and assessors rather than judgmental right-wrong dualism.