Communication & Relationships with Patients & Colleagues

Rationale

The physician-patient relationship forms the core of the practice of internal medicine. Many physicians view it as the most satisfying aspect of their work. The medical interview and the relationship between physician and patient are important diagnostic and therapeutic tools. Effective communication skills are needed for a physician to serve as an effective patient advocate. Communication skills also are needed to address patient concerns and requests. Proficiency in communicating with patients results in increased patient and physician satisfaction, increased adherence to therapy, and reduced risk of malpractice claims.

The student on the internal medicine clerkship interacts with a diverse array of patients, physicians, and other health team members, necessitating proficiency in communication and interpersonal skills. Students also witness how diversities of age, gender, race, culture, socioeconomic class, personality, and intellect require sensitivity and flexibility. The result of proficiency in communication and interpersonal skills is increased satisfaction for both doctor and patient.

Prerequisite

Basic competency in patient interviewing, obtained in physical diagnosis courses or in other required courses.

Specific Learning Objectives

1. Knowledge: Each student should be able to describe:
   1. how patients’ and physicians’ perceptions, preferences, and actions are affected by cultural and psychosocial factors and how these factors affect the doctor-patient relationship.
   2. the role and contribution of each team member to the care of the patient.
   3. the role of psychosocial factors in team interactions.
   4. the role of the physician as patient advocate.
2. Skills: Each student should be able to:
   1. demonstrate appropriate listening skills, including verbal and non-verbal techniques (e.g., restating, probing, clarifying, silence, eye contact, posture, touch) to demonstrate empathy and help educate the patient.
   2. demonstrate effective verbal skills including appropriate use of open- and closed-ended questions, repetition, facilitation, explanation, and interpretation.
   3. determine the information that a patient has independently obtained about his/her problems.
   4. identify patient’s emotional needs.
   5. seek the patient’s point of view and concerns about his/her illness and the medical care he/she is receiving.
   6. determine the extent to which a patient wants to be involved in making decisions about his/her care.
   7. assess patient commitment and adherence to a treatment plan taking into account personal and economic circumstances.
   8. work with a variety of patients, including multiproblem patients, angry patients, somatizing patients, and substance abuse patients.
   9. work as an effective member of the patient care team, incorporating skills in interprofessional collaboration.
   10. Give and receive constructive feedback.
3. Attitudes: Each student should:
   1. work hard to develop effective doctor-patient communication skills.
   2. take into consideration in each case the patient’s psychosocial status.
   3. demonstrate respect for patients.
   4. demonstrate actively involving the patient in his/her health care whenever possible.
   5. demonstrate teamwork and respect toward all members of the health care team, as manifested by reliability, responsibility, honesty, helpfulness, selflessness, and initiative in working with the team.
   6. respond pertinently to patient concerns.
   7. attend to or advocate for the patient’s interests and needs in a manner appropriate to the student’s role.