University of Iowa Hospitals and Clinics

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Communication Key to Doctor-Patient Relationship

Scientific knowledge, clinical competence and professional credentials all are important for a doctor to bring to a doctor-patient relationship. But for patients, it’s more often about doctors who know how to ask the right questions, listen carefully and earn their trust.

In short, it’s about communication, which directly influences a patients’ adherence to treatments, recall and understanding of diagnoses and medical information and overall satisfaction.

But are good physician-communicators a special breed, blessed with an inherent ability to connect with patients? In other words, can medical students learn to communicate effectively with patients?

“Definitely,” said Marcy Rosenbaum, PhD, the Dr. Harold A. Myers Distinguished Professor in family medicine and a faculty member in the UI Carver College of Medicine’s Office of Consultation and Research in Medical Education. “In medicine, being a good communicator is a skill. It’s not simply a matter of being nice to patients or having a sunny personality. If that were the case, only certain people could do it and be good at it.”

Instead, UI Carver College of Medicine educators are raising the bar so that all medical students can communicate effectively, in both common and more challenging clinical situations.

Physician-patient communication has been part of the college’s curriculum for years, most notably as part of the four-semester Foundations of Clinical Practice course taken by first- and second-year students. Therein lies the challenge, says Rosenbaum, who has taught many of these FCP sections.

“In the past, students were typically taught about the medical interview and other communications-related material during the pre-clinical years—before they actually saw patients,” she said. “While the material was good, it simply wasn’t reintroduced much—or at least not in a unified, consistent approach—once students began their clinical rotations in their third and fourth years.”

But that has changed. Since the fall 2008 semester, Rosenbaum, along wth Bill Iverson, MD, associate professor of internal medicine, and other college educators have implemented the Calgary-Cambridge method to teach communication skills.

The Calgary-Cambridge method focuses on the medical interview—arguably the most important part of a doctor-patient interaction. The model teaches and reinforces the use of open-ended questions and attentive listening during the interview, which allows patients to explain their medical problems in their words. This approach allows a physician to better assess a patient’s concerns and expectations. Moreover, it helps a doctor successfully negotiate with the patient the main reason for the clinic visit, manage doctor and patient expectations and implement the appropriate treatment and follow-up.

“What’s great is the model brings together the content of the medical interview and the needed interviewing skills and sets it in the context of what really happens in a clinic situation,” said Ellen Franklin, curriculum coordinator of the College’s Performance-Based Assessment (PBA) program, which assesses students’ skills in simulated clinic situations.

For example, physicians may often assume that the first problem a patient describes is the main reason for the visit, and that becomes the focus of the rest of the interview. “But that’s not always the case, especially if the problem is of a sexual nature or in some way embarrassing,” Franklin said. “A key to this model is learning how to use listening and negotiating skills to determine which medical issue you’ll address today, and what you’ll do to address the other issues.”

The Calgary-Cambridge method covers how to initiate an interview session, gather patient information, build a relationship with the patient, and ensure the patient’s understanding and agreement on the treatment and next steps.

“By mastering these core principles, things like delivering bad news, dealing with an angry patient, or handling other difficult or unique communications situations are not insurmountable,” Franklin said.

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