Danielle Hanuschak

Erin Workman
ENC 2135
4 March 2015
Patient-Physician Communication
Many individuals have had to communicate with a doctor or physician of some kind at
one point during their life. The forms of communication that are used are usually oral or written.
The ways physicians communicate with patients depends on on several factors, such as the
circumstances involved with the patient. For instance, the communication pattern towards
patients who are healthy versus patients who are terminally ill are significantly different.
Sometimes doctors have to relay devastating news to patients, and how they do this is a topic
under study. The way health care providers communicate with patients has changed significantly
over time due to to the intervention of technology and computers as well. Questions have been
raised on the effectiveness of patient-physician communication, and how the level of
communication effects patients as a whole. In an attempt to answer some of the questions about
communication between patients and physicians, the importance of communication and its styles
will be explored. In the process of exploring this topic, the impact they have on patients will be
looked into as well.
Communication skills are one of the key assets physicians must have in order to practice
medicine effectively. Without these skills, the physicians would essentially be unable to help
patients because the transfer of knowledge from patient to physician would not exist. Its
important for the doctor to fully understand exactly how the patient is feeling in order to

properly treat them, and therefore they must be able to communicate efficiently. According to
Zill et al., researchers at the department of medical psychology in Germany, effective
communication with health care providers is relevant for physical and psychological health
outcomes as well as the patients adherence (1). In order to provide the best care possible for
patients, physicians need to make sure that they are exchanging information clearly while
assisting to the emotional uncertainties patients may be having. In a study conducted by
Zolnierek et al., the patient-physician communication was found to be significantly positively
correlated with patient adherence (qtd. Zill et al. 1). Therefore, the better the physicians
communication skills, the better outcomes for the patient. Outcomes linked to physician-patient
communication include patients trust in the doctor, understanding, motivation, involvement, and
rapport (2). Patients should feel welcomed by the doctor and be able to open up to them. Trudel,
Leduc, and Dumont, who are involved in medical research, found that if women who have breast
cancer perceived that they had received good communication skills by the physician in terms of
information exchange and that they were empathic and compassionate with them at diagnosis,
then they could go through the treatment phase with greater ease (532). By having the physician
communicate accordingly, the patient will therefore have better outcomes due to the increased
level of commitment in their treatment, which leads to better health overall.
There are different methods of communication doctors utilize in order to enhance the
physician-patient relationship. In an interview with Samuel Chukwuma, a physician who has
specialized in emergency medicine for over twenty years, he mentions the ways in which he
communicates with patients. One of the key points he emphasized was to engage the patient in
conversation. He explains that asking questions is an important tool in receiving information

from the patient. He explains that even though he read the patients chart and thinks he knows
what to do next, its extremely important to consult the patient first and see exactly how they are
feeling. Although communication involves mostly speaking, he states that eye contact is crucial
in enhancing communication. Body language is another factor Dr. Chukwuma discusses. Often
times he will sit down on a chair next to the patient in order to provide a more casual, less
intimidating setting, which usually allows the patient to be more relaxed and open up more, thus
improving overall communication.
The need for effective communication in the patient-physician relationship has been
noticeably more important throughout the evolution of medicine. The role of the physician has
ultimately been transformed throughout history. Ferreira-Padilla et al. examined how
communication within the heath care system has increasingly been implemented throughout the
years. They explain how the seventies were a turning point for communication skills teaching
because a shift from physicians believing that communication skills were innate to having
courses about communication for physicians occurred (311). The introduction of courses that
provide programs in communication skills emphasizes the true importance of communication in
health care, and the importance of person-centered medicine. They also explain that:
Since communication skills can be learned and mastered by practice, experiential
learning is important, and individualized and interactive format of teaching should
be applied adhering to the principles of evidence-based and person-centered
medicine. Human relationship is what matters most! (313)
The way physicians acquire these skills are through practice, and they are not innate skills like
physicians once thought almost fifty years ago. Since the overall health of the patient is

dependent on how well the physician can communicate, courses on these skills have been
implemented in their curriculum.
Patient-physician communication does not always occur in person. With the advancement
of technology, communication can happen from a distance. Among the options that can be used
for communication include E-mails and Facebook. Lee et al., who all are involved in the medical
field, found through a study that patients have a strong interest and a surprisingly high use of
Email and Facebook for communicating with physicians (48). The use of technology for
communication has increased greatly. They explain how the technology incorporated with the
messaging system allows patients and physicians to Email each other in a data-secure
environment, and its availability is likely to increase in the coming years (49). Not only will
patients be able to communicate with their health care providers without being there in person,
but they are ensured that their information is safe, which allows them to be more confident with
the communication style. Instead of prohibiting the use of communication through social media,
patients suggest that they should all be educated on the correct use of social media since the tool
can be used for clinical communication. Therefore, communication through technology is seen as
another gateway for better patient-satisfaction and overall health.
Not only is technology used to communicate with patients at a distance, but technology
such as computers are sometimes used by physicians while patients are in the room. In a
communication study conducted by Sobral, Rosenbaum, and Figueiredo-Braga, all of which who
are involved in medicine through universities and health centers, it was found that physicians
perceive a negative impact on communication from the use of computers in primary care
consultations, while patients see a positive impact (1575). Not only does the computer itself

interfere with the communication, but the setting of the consultation room also impacts the
patient-physician relationship. The arrangement of furniture in the office and the placement of
the computer screen on the desk can effect overall communication. The most favorable location

of the computer for better patient-physician communication was found to be at position C in

figure 4 by a percentage of 42.4% from physicians. The most favorable arrangement of furniture
in the office was found to be option D in figure 2 by 41.7% (1574). Although computers assist
physicians with gathering and providing information, they report that it negatively influenced
consultation length, confidentiality, and their ability to look, listen and understand the patient
(1575). Therefore, the introduction of computer use in patient-care settings can be seen as a
controversial topic since patients prefer them whereas physicians do not.
Proper communication skills are extremely important in helping patients, but sometimes

other forms of communication are necessary. In the magazine article Communication With Our
Patients is Vital by Dr. Mike Knapton, associate medical director at the British Heart
Foundation, he stresses the importance of health care providers having exemplary
communication skills (30). He explains that over 150 GPs (general practitioners) revealed that
more than three-quarters of us have had a patient request another consultation to clarify issues
raised after their first appointment. This finding suggests that poor communication from a
physician leads to patients being unsatisfied and possibly angered. Sometimes physicians feel as
though they are perceived as a fob-off if they give their patients a leaflet about their condition.
However, Dr. Knapton explains that leaflets and booklets are some of the most underused
resources and can hugely improve a patients understanding of their condition - especially
following their consultation. Not only can verbal communication be utilized, but its important
to utilize other written forms of communications because they can ensure overall patient
satisfaction and health.
The success of physician-patient relationships is correlated with effective
communication. Sometimes physicians have to deliver bad news, sometimes they deal with
angry patients, and sometimes they have to deal with patients who are seeking drugs or wont
follow treatment due to financial concerns. In a magazine article titled Communication
Strategies for Difficult Physician-Patient Interactions by Maureen Leahy, she describes several
methods for dealing with these tough situations. One method is the 4 Es model - engagement,
empathy, education and enlistment, which provides a framework for successfully dealing with
difficult situations (14). Doctors can use this model to increase patient understanding and overall
communication. Another strategy includes the HARD protocol, developed by Rober A.

Buckman, MD, PhD, for volatile situations. For drug-seeking patients, a communication style
that includes empathy, tempered with honestly, particularly about any discomfort in being
pressured to prescribe narcotics should be used. Dr. Andrew Wong recommends that physicians
should not argue with the patient about his or her pain level, but do enlist the patients help and
cooperation in carrying out any agreements that are made (14). With each different situation,
whether it is an angry patient or drug-seeking patient, different communication styles can be
utilized in order to enhance communication and patient satisfaction.
Often times physician-patient communication is more complex then just relaying
information to a patient. Perhaps a patient might be angry or upset. The YouTube video Doctor
Patient Communication by Dr. Drummond illustrates steps in which to follow when
encountered by an angry patient. He describes a universal upset person protocol that doctors
can utilize to give patients a safe place to vent their feelings so doctors can move into the clinical
part of their office visit. Dr. Drummond includes six steps physicians should follow to enhance
their communication with patients. The steps include recognizing that the patient is upset, asking
them to tell you about it, apologize for the way that theyre feeling, asking what they want the
physician to do to help them, offer a treatment plan, and then explaining the importance of
understanding one another (1:53). After these steps are completed, then the office visit can be
completed, according to Dr. Drummond.
Communication styles physicians use are also dependent on the circumstances of the
patients. The way in which physicians communication with those who are ill is different from the
way they communicate with those who are just coming in for a check-up. However, sometimes
the patient is in such bad condition that the physician must communicate with the family in order

to progress to the next steps of treatment. In a study conducted by Mathew et al., who are all
involved with medicine, they found that clinical-family communication has to be adequate and
effective for medical decision making (52). The quality of communication is related to the
comprehension and satisfaction levels in family members of patients. They found that the family
members comprehension level of the patients illness was poor, at 71.2% (53). This suggests that
the doctors in the intensive care unit often do not recognize when a family doesnt comprehend
what theyve said. In order to solve this issue, health care providers should spend extra time and
effort in communicating with patients who are involved in an emotionally stressed state. It was
recommended that a family information leaflet be made available to families to further improve
communication (53). By using a brochure to convey information about ill patients, a new style
of communication is utilized, changing from verbal communication to written.
The communication practices physicians use for patients with end-stage cancer is
different from those that they use with healthy patients as well. In an article by Mohan et al., a
medical doctor, it was found that a high prevalence of eliciting preferences, values and goals even in this time-pressured setting - is reassuring, and in the stimulated environment affects
whether the patient receives palliation (955). Although verbal communication was understudy,
nonverbal cues such as posture and facial expressions also effected the perception of
communication. In communicating with patients, physicians will first share the prognostic
information with them, then they will allow the patient or family member to respond to what
they said. The physician will then respond to their preferences. Physicians carefully explain the
treatment options, offer their recommendations, and focus on improving the quality of life for
patients with end-stage cancer (953). Although the patient or family member may not agree with

their treatment plans, by eliciting their preferences and linking their recommendations to those
preferences, physicians are able to establish a joint medium of treatment with the patient.
Sometimes conveying hard-to-hear news to patients and their family members is a
difficult task for physicians. In order to communicate effectively, different styles are
implemented. According to Casarett et al., although conversations near the end of life can pose
daunting challenges to physicians, oncologists frequently use figurative language in
conversations that they perceive to be difficult (259). Figurative language can be used to
reassure or convince, rather than just improving understanding. Metaphors and analogies offer
additional ways to improve health care providers communication skills. Treatment plans for
patients with cancer can be complex and difficult to understand, which would only worse then
anxiety among them. In order to help calm their nerves and improve communication, a doctor
might say a certain type of cell is like weeds in your garden that take over a garden, it chokes
everything else out. And so the way to treat it is to use a weed killer, so you get rid of all that bad
stuff. And slowly, the good stuff comes back (258). Using the metaphors and analogies allow
better understanding of what patients are going through and what they should expect.
Numerous studies have concluded the importance of communication between physicians
and patients as it is correlated to the patients overall health outcomes and satisfaction. Different
communication styles are used depending on the circumstances of the patient, such as if they are
ill or even angry. Technology has influenced the way in which patients communicate with
physicians, both positively and negatively. Both written and verbal communication is essential in
treating patients as well. Implementing different styles of communication through the use of

analogies and metaphors has been proven to enhance communication in tough circumstances. I
can conclude from this research that having exemplary communication skills with patients is
vital for physicians, as it can alter the outcome of the patient. More research on these
communication skills should still be done in order to find new ways to improve it even further,
thus helping patients with their treatment. From my research, it is clear that without proper
communication skills, the heath of the patient is in jeopardy and in order to maximize better
outcomes, communication needs to be utilized correctly.

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