The fact that competency in communication skills is a mandate of large medical governing organizations reflects today’s emphasis on the importance of communication skills. In 2001, the Institute of Medicine declared that patient-centered care was one of six objectives for improving health care in the 21st century (IOM, 2001). In 1999, the Association of American Medical Colleges called for greater teaching of communication skills (AAMC, 1999) and followed up in 2004 by implementing communication skills assessments in the Step 2 Clinical Skills exam (NBME, 2010). In 2003, the Accreditation Council for Graduate Medical Education requested competency-based teaching and assessment of “interpersonal and communication skills” as a core clinical competency (ACGME, 2007). The American Board of Medical Specialties adopted the same competencies or re-certification (ABMS, 2016).
Good communication forms the basis of rapport, trust and professionalism (Gabay, 2015). Further, because of computers, electronic health records and the internet, better communication is more necessary than ever to obtain accurate histories and assist patients in their navigation of the health system, as well as to contain cost (Lazare, 1995; Stewart, 2011; Epstein, 2005; Wright, 2008). While communication deficiencies produce negative outcomes, improved communication results in higher satisfaction both for patients and their clinicians, and good evidence shows that it has a positive downstream effect on measurable medical outcomes.
Consider the outcomes of clinical encounters. Greater patient and clinician satisfaction, greater patient understanding and acceptance of treatment plans, reduced patient distress and fewer lawsuits are key outcomes related to communication skills. Interventions to improve clinician-patient communication can lead to improved biomedical outcomes, such as better self-management of diabetes, reduced postoperative morbidity and better coping and quality of life in cancer. Here are studies about the value of communication skills.
Increased satisfaction with care and increased trust in the clinician (Boissy, 2016; Gabay, 20015; Dwamena, 2012; Haskard, 2008; Luxford, 2015; Oliveira, 2015; Street, 2012; Rao, 2007; Lelorain, 2012; Rathert, 2013; Tulsky, 2011; Venetis, 2009; Pollak, 2016).
Improvement in subjective measures such as pain (Sarinopoulos, 2013; Kravitz, 2012; Oliveira, 2015), response to pain management modalities such as acupuncture (Street, 2012) and symptoms in chronic functional disorders (Di Palma, 2012).
Improved functional and overall health status (Kaplan, 1989) and psychologic quality of life (Sep, 2014; Trevino, 2015; Oliveira, 2015; Verheul, 2010; Robinson, 2013; Lee, 2010; Luxford, 2015; Lelorain, 2012).
Reduced suffering from cancer (Arora, 2009; Bakitas, 2009; Robinson, 2013; Tulsky, 2011; Venetis, 2009; Lelorain,2012) and at the end of life (Temel, 2010; Wright, 2008; Lautrette, 2007).
Improved self-management, perceived autonomy, activation and engagement in many settings (Zolnierek, 2009; McCabe, 2013), including blood pressure medication adherence (Schoenthaler, 2009) and HIV self-management (Flickinger, 2016).
Improved patient adherence (Gabay, 2015) with medication in chronic disease (Moral, 2015) and with treatment plans (Fuertes, 2007).
Clinicians who communicate well report higher satisfaction (Boissy, 2016) and less burnout:
Clinicians who use communication skills, such as agenda-setting for a clinical encounter (Baker 2005), motivational interviewing (Pollak, 2016) or specific communication skills for managing patients with dementia (Luxford, 2015), report increased satisfaction with their encounters and decreased frustration and burnout.
Physicians who participated in a mindful communication program experienced short-term and sustained improvements in well-being and attitudes associated with patient-centered care (Krasner, 2009). Similarly, a cohort of humanistic physicians believes that treating their patients humanistically serves to prevent burnout in themselves (Chou, 2014).
Hospital readmissions due to heart failure were reduced with the use of a patient centered curriculum (Record, 2011).
Patient-centered care was associated with a lower hazard ratio of death from myocardial infarction (Meterko, 2010).
Improved communication and coordination at the system level is one of several factors that distinguishes high-performing from low-performing hospitals in terms of mortality after acute myocardial infarction (Curry 2011).
A systematic review of cardiovascular outcomes affected by clinician-patient communication includes data on reduction of 10-year risk of coronary heart disease and lower incidence of post-surgical tachyarrhythmia (Schoenthaler, 2014).
Diabetes Mellitus Outcomes
Patients of more empathic physicians had better glycemic control (Hojat, 2011).
Serum glucose levels, blood pressure, and LDL improved with patient-centered counseling (Rocco, 2011; Kelley JM, 2014).
Patients with better glycemic control and cholesterol management were more likely to report that their physicians showed them respect, and those patients were more likely to recommend their physicians to others (Francis, 2014).
Patients who perceived their trauma surgeons as being more empathic had better medical outcomes after hospitalization (Steinhausen, 2014).
Postoperative delirium was reduced as a result of a perioperative psycho-educational intervention (Lee, 2013).
Smith’s Patient-Centered Interviewing (Smith, 2012) cites studies from the 1990s that report improvements in surgical recovery and postoperative outcomes with patient-centered communication.
Positive communication skills have a favorable impact on cancer outcomes, ranging from improved cancer screening adherence (Fox, 2009) to improved cancer survival (Temel, 2010; Mustafa, 2013).
Increased patient-centeredness is associated with reduced costs for diagnostic testing (Stewart, 2011; Epstein, 2005).
Addressing communication with family members about decisions at the end of life reduced ICU admissions and unnecessary ventilation and resuscitation efforts (Wright, 2008; Zhang, 2009).
Good communication skills are necessary for clinician satisfaction and patient satisfaction and outcomes. Contact us if you’d like a free 30-day trial subscription to DocCom.
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