Doctor-patient communication. Clinical implications of social scientific research

TLDR

Social‑science research has identified key problems in doctor‑patient communication, including structural barriers that hinder effective information exchange, and has made communication skill development a goal of primary‑care training programs. This review aims to examine the social‑science literature to clarify how improved doctor‑patient communication can be achieved and to inform medical education and clinical practice. The authors discuss how training programs and clinical standards can promote better communication by addressing both verbal and nonverbal aspects and by recognizing the influence of patient, doctor, and situational factors. The review shows that doctors frequently underestimate patients’ desire for information, misperceive the information‑giving process, and that communication—shaped by patient, doctor, and clinical characteristics—affects satisfaction and compliance, while a high‑control, doctor‑initiated style often neglects patients’ life world.

Abstract

Research in the social sciences has clarified the nature and problems of doctor-patient communication. The development of adequate communication skills is now a goal of training programs in the primary-care specialties. Social structural barriers impede effective communication, however, and information giving remains problematic. Doctors tend to underestimate patients' desire for information and to misperceive the process of information giving. The transmission of information is related to characteristics of patients (sex, education, social class, and prognosis), doctors (social-class background, income, and perception of patients' desire for information), and the clinical situation (number of patients seen). Doctors' nonverbal communication abilities are associated with outcomes of medical care such as satisfaction and compliance. Regarding the sociolinguistic structure of communication, doctors often maintain a style of high control, which involves many doctor-initiated questions, interruptions, and neglect of patients' "life world." Training programs and standards of clinical practice should emphasize that improved doctor-patient communication is both desirable and possible.A review is provided of the social science literature on doctor-patient communication, with emphasis on its implications for medical education and clinical practice. The transmission of information is related to characterisitics of patients (sex, education, social class, and prognosis), doctors (social class background, income, and perceptions of patients' desire for information), and the clinical situation (number of patients seen in a day). The role of doctors' nonverbal communication in affecting outcomes of care and the sociolinguistic structure of medical communication are also discussed.