CM1.9-10 | CM1.9-10 | Communication in Doctor-Patient Relationships — Summary & Reflection

KEY TAKEAWAYS

Effective doctor-patient communication is a clinical competency with measurable patient outcomes: poor communication causes non-adherence (2-3x higher risk), diagnostic error, patient complaints, and health inequity. The doctor-patient relationship is structured by four models (Emanuel & Emanuel): paternalistic, informative, interpretive, and deliberative — the choice depends on clinical context and patient autonomy. Verbal skills include open questions (for breadth and patient perspective), closed questions (for specific facts), plain language, and chunking with checking. Non-verbal communication (eye contact, posture, tone, proxemics) carries a large share of the emotional content of communication. Active listening — attending, reflecting, paraphrasing, summarising — is the foundation of therapeutic communication. The Calgary-Cambridge framework provides a five-phase consultation structure; ICE (Ideas, Concerns, Expectations) explores the patient's perspective. Teach-back is the evidence-based method for verifying patient comprehension. Breaking bad news uses the SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathy, Strategy). Motivational interviewing (Miller & Rollnick) addresses ambivalence about behaviour change through empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. Communication skills are assessed by OSCE, mini-CEX, and PREMs, and developed through deliberate simulated practice with structured feedback.

REFLECT

Recall a recent interaction you observed — in a hospital, at a PHC, or even with a healthcare provider in your own life — where communication went well or poorly. Using the frameworks from this module, analyse what specific communication behaviours (verbal or non-verbal) contributed to the quality of the interaction. If communication failed: which Calgary-Cambridge phase did the breakdown occur in? Which model of doctor-patient relationship was the doctor operating from — and was it appropriate for the situation? If communication succeeded: which specific technique (open questions, empathy, summarising, teach-back) made the difference? Now consider: what is the one communication habit you most want to develop before your first real clinical posting?