REVIEW ARTICLE

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 how
to communicate well with patients. Traditionally, communication in medical school curricula was incorporated informally as part
of rounds and faculty feedback, but without a specific or intense focus on skills of communication per se. It has been shown that
good doctor-patient communication has an impact on better health outcomes, higher compliance to therapeutic regimens in
patients, higher patient and clinician satisfaction, and a decrease in malpractice risk. It is the need of time to conduct more research
in this area and to actively include teaching the art of communication skills in undergraduate and postgraduate learning
programmes 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-patient

communication?
z

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
providers 2. It has been shown that the doctors

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 patients 3,4. 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.
z

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 patients
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: personfocussed, 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.
z

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 better

doctor-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.

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 patients
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 claims 10. 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.

Journal, Indian Academy of Clinical Medicine

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 patients 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 (Timerelated).
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,

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originally developed by Julian Bird for the purpose of

educating medical students 13 , represents a
comprehensive foundation for understanding doctorpatient 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 patients
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 doctorpatient communication like patients perceptions 22,
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

210

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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AZTOR

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