Doctor Patient Relationship.

Mayo Clin Proc, February 2003, Vol 78

Improving Physician-Patient Communication

211

Concise Review for Clinicians

Two Words to Improve Physician-Patient Communication: What Else?
PATRICIA A. BARRIER, MD, MPH; JAMES T.-C. LI, MD, PHD; AND NORMAN M. JENSEN, MD
tient disclosure of problems and enhance physician-patient communication. This, in turn, can improve health
outcomes, patientcompliance, and patient satisfaction and
may decrease malpractice claims. Physicians can improve
their communication skills through continuing education
and practice.

The medical interview is the physician’s initial and perhaps most important diagnostic procedure, but physicians
vary in their abilities and skills in physician-patient communication. Information gathering, relationshipbuilding,
and patient education are the 3 essential functions of the
medical interview. A physician-centered interview using a
biomedical model can impede disclosure of problems and
concerns. A patient-centered approach can facilitate pa-

Mayo Clin Proc. 2003;78:211-214

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patients. Obtaining the patient’s medical history is the
most frequent and the most important procedure thatphysicians perform. Eliciting a complete and clear medical
history depends on good physician-patient communication skills. Natural communication skills in physicianpatient communication vary as do the quality and quantity
of training in medical school and residency. Physician
communication skills can improve with attention and
practice.
In an editorial, Dr F. Daniel Duffy1 of the American
Board ofInternal Medicine cited the many advances in
communication skills that are used by politicians and advertisers to exert influence. Physicians and behavioral and
social scientists have also been carefully studying the
medical interview. Dr Duffy indicated that physicians must
be as attentive to developing and refreshing communication skills as they are to developing and refreshing diagnostic andtherapeutic skills.

he history and physical examination are completed
and tests ordered. The diagnosis has been discussed
with the patient. The patient has prescriptions and instructions for a follow-up visit. While the physician and patient
are walking to the examination room door, the patient says,
“Oh, by the way, Doc….”
Now the patient’s most important concern is expressed,
and thereal reason for the visit is revealed. The physician
often must start over despite the previous work and time
invested. Why does this happen? Frequently this occurs
because of what the physician does and fails to do during
the medical interview. This can be avoided in most situations if the physician uses a more patient-centered approach to the medical interview.
WHY SHOULD PHYSICIANS BECONCERNED WITH
PHYSICIAN-PATIENT COMMUNICATION?
Learning about the true chief complaint at the conclusion of
a patient visit is not only inefficient but also impedes
proper diagnosis and treatment. Poor communication also
negatively affects patient compliance and outcomes. Patients complain that physicians do not listen, are hurried,
and do not allow them to participate in their care. In thismanaged-care era, physicians complain that they are hurried and hassled and have insufficient time with their

FUNCTIONS OF THE MEDICAL INTERVIEW
The American Academy on Physician and Patient (AAPP)
adopted a functional framework for the medical interview.2
Within this framework, the 3 functions of the medical
interview are information gathering, relationship building,
and patient education.In the Kalamazoo consensus statement, the elements of
physician-patient communication are expanded to 7 essentials.3 The key element is establishing a relationship by
opening the discussion, gathering information, understanding the patient’s perspective, sharing information, reaching
agreement on problems and plans, and providing closure.
All 3 functional aspects occur concurrently during a...