Table 1

Themes and observable behaviours in communication with patients

Listening skills
  • Uses both general and active listening skills to facilitate communication

  • Appropriately looks at the patient while the patient is talking

  • Allows time for appropriate silences

  • Feeds back to the patient what he or she understood from the patient

  • Provides appropriate nonverbal responses to the patient’s statements

  • Responds to important cues at all times (eg, it is not appropriate to go on with regular questioning when the patient reveals important life or situation changes such as “I just lost my mother”)

  • Clarifies jargon when used by the patient

  • Comprehends what the patient says

  • Lets the patient tell his or her story (does not interrupt the patient inappropriately)

  • Does other things while the patient is talking (eg, looks at computer chart, takes telephone calls)

Language skills
  • Can be understood by the patient

  • Is able to converse at an appropriate level for the patient’s age and educational level

  • Uses appropriate tone for the situation to ensure good communication and patient comfort

  • Asks open- and closed-ended questions appropriately

  • Checks back with the patient to ensure understanding (eg, “If I say this, am I understanding you correctly?”)

  • Facilitates the patient’s story (eg, “Can you clarify that for me?”)

  • Provides clear and organized information in a way the patient understands (eg, test results, pathophysiology, side effects) and checks back to ensure the patient understands

  • Provides explanations to accompany examinations or procedures

  • When first meeting a patient, clarifies how the patient would like to be addressed

  • Fails to greet the patient

  • Interrupts the patient inappropriately

  • Uses inappropriate word choices for the patient’s level of understanding (eg, use of scientific language that the patient cannot understand, overuse of jargon)

  • Displays inappropriate anger

  • Uses inappropriate humour

  • Uses paternalistic language (eg, calls the patient “dear”)

  • Uses offensive language (eg, swearing)

  • Shouts or uses excessively loud speech

  • Asks multiple questions without awaiting the answers

  • Has language skills that are insufficient to be easily understood by most patients (eg, patient cannot understand what the physician is saying)

  • Clearly articulates and communicates thoughts in a written fashion (eg, letters, educational materials, instructions)

  • Writes legibly

  • Written material is organized so that the patient can understand (spelling, grammar and punctuation must be sufficient to permit understanding)

  • When providing written information, chooses materials that are appropriate to the patient’s level of understanding

  • Uses abbreviations that are not understood by the patient

Nonverbal skills
  • Is conscious of the effect of body language on communication with the patient and adjusts it appropriately when it inhibits communication

  • Sits while interviewing the patient (to convey the feeling of providing the patient more time and attention)

  • Ensures eye contact is appropriate for the culture and comfort of the patient

  • Is focused on the conversation

  • Adjusts demeanour to be appropriate to the patient’s context (eg, is pleasant, appropriately smiles, is appropriately serious, is attentive, is patient and empathetic)

  • Communicates at eye level (eg, children, patients who are bedridden)

  • Ensures physical contact is appropriate to the patient’s comfort

  • Fidgets

  • Hygiene or dress inhibits communication

  • Gets too close (eg, does not respect others’ personal space)

  • Is aware of and responsive to body language, particularly feelings not well expressed in a verbal manner (eg, dissatisfaction, anger, guilt)

  • Responds appropriately to the patients discomfort (eg, gets a tissue for a patient who is crying, shows appropriate empathy to the patient’s difficulties)

  • Verbally checks the meaning of body language (eg, “You seem nervous/upset/uncertain/in pain; is that right?”)

  • Comments on behaviour or nonverbal actions of the patient when appropriate (eg, “You seem quiet/unhappy/angry/worried/in pain”)

  • Modifies actions during examination or history taking in response to patient’s discomfort (eg, adjusts angle of table when a patient is short of breath during an abdominal examination)

  • Misses signs that the patient does not understand what is being said (eg, blank look, look of astonishment, look of puzzlement)

Cultural and age appropriateness
  • Adapts communication to the individual patient for reasons such as culture, age, and disability (eg, young child or teenager, speech deficit, hearing deficit, language difficulty)

  • Adapts communication to the adolescent (eg, offers to see the patient independently, respects capacity to make decisions, acknowledges issues of confidentiality, specifically directs questions to the adolescent, is not judgmental)

  • Adapts communication style to patient’s disability (eg, writes for deaf patients)

  • Asks about need for and arranges for interpreter

  • Speaks at a volume appropriate for the patient’s hearing

  • Adapts communication style based on the patient’s cultural expectations or norms (eg, other family members in the room)

  • Identifies and adapts manner to the patient’s cultural needs

  • Uses appropriate words for children and adolescents (eg, pee vs void)

  • Ignores the patient while exclusively engaging the caregiver, especially with children, the elderly, and patients with cognitive impairment (eg, no questions to the patient, patient not involved in management plan)

  • Makes assumptions based on patient’s appearance or dress (ie, stereotyping)

  • Uses colloquialisms that the patient does not understand

Additudinal skills
  • This permeates all levels of communication. This includes the ability to hear, understand, and discuss an opinion, idea, or value that might be different from the physician’s own, while maintaining respect for the patient’s right to decide for himself or herself. Communication conveys respect for the patient

  • Expresses interest in the patient’s opinion

  • Is empathetic

  • Maintains an appropriate attitude in response to inappropriate or offensive language or comments made by the patient

  • Appears rude

  • Appears impatient

  • Displays irritation or anger

  • Belittles the patient

  • Trivializes or dismisses the patient’s ideas or concerns

  • Is sarcastic

  • Appears intimidating

  • Appears arrogant (eg, ignores the patient’s concerns or opinions about the management plan)