Communication and the medical interview. Strategies for learning and teaching.

Abstract

The broad goal of this article is to direct clinician-educators to ways to improve their knowledge about medical interviewing and their communication skills, as well as to note ideas and resources for teaching in this area. Our specific objectives are to outline the knowledge base, specific skills, and attitudes and values relevant to effective communication in the context of the clinical interview, and to suggest strategies and resources that can be used by clinician-educators to learn and teach them. The article is not intended to be a critical review of the literature on communication and interviewing, nor is it an in-depth discussion of the knowledge base and skills to be learned. For these we refer the reader to specific references, texts, and other resources. This article will provide a summary road atlas to the broad field of communication and medical interviewing; cited literature and suggested learning resources will provide local detail maps for readers who are interested in more in-depth treatments of specific areas. Why should clinician-educators be interested in communication and interviewing? Effective communication in clinical settings increases the likelihood that (1) the information gathered from patients to make diagnostic assessments is accurate and reliable; (2) patients recognize that the physician is genuinely interested in them and their care; (3) physicians and patients reach common ground on diagnosis and treatment; and (4) patients are motivated to play an active role in their own care.1,2 In this way, the interview determines the accuracy of the diagnostic assessment as well as the quality of the doctor-patient relationship, thereby affecting the entire diagnostic-therapeutic process. In short, better communication leads to better diagnosis and treatment. Better communication leads to better outcomes. Research has documented that communication during the interview is positively related to specific illness outcomes,3,4 as well as to satisfaction among patients5,7 and physicians.8 On the other hand, poor communication has been related to such adverse events as malpractice suits9,10 and patient decisions to leave practices or health care organizations.11 In the clinical setting, most physicians and their patients benefit from high-quality, effective communication skills. Clinician educators will find it especially valuable to improve their communication skills, as strong skills will also bring important benefits in the educational and academic settings in which they work. In the educational setting, effective teaching and learning depend greatly on the exchange of information and quality of the relationship between students and teachers.12,13 Skills that promote effective communication in the clinical setting are also effective in the educational setting. Clinician-educators are in a unique position to use this overlap of skills. It is often possible to model specific communication skills for students during teaching sessions, then explicitly point out their parallel use with patients. This can result in powerful experiential learning. Students who directly experience effective communication (e.g., through the teacher's expressions of empathy or partnership, or encouragement of active participation and autonomy) may be more likely to use those skills with their patients. The benefits of effective communication also extend to academic life. As clinician-educators interact with peers and superiors in the academic environment, they benefit from their own communication skills such as attentive listening, empathy, negotiation, and limit setting. Again, what is learned in one setting can be appropriately applied to others. Continuing mentoring and reflection will facilitate this transfer of skills among clinical, educational, and academic settings. Some have argued that being an effective communicator is part of the “art” of medicine, implying that the ability to communicate is a natural talent with which one is or is not born.14 We disagree. Communication skills are specific and observable, and can be evaluated objectively. There is ample evidence that continuing education programs designed for physicians in practice improve skills,15 18 and research with medical students has shown that the benefits from training persist years after the course has been completed.19 Knowledge and skills associated with effective communication and interviewing can be improved through practice, using the strategies and resources we outline in this article.