Medical Council of Canada

Communicator

Communicator

As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after medical encounters.*

Description

Physicians enable patient-centered therapeutic communication through shared decision-making and effective dynamic interactions with patients, families, caregivers, other professionals, and other relevant individuals. The competencies of this role are essential for establishing rapport and trust, formulating a diagnosis, delivering information, striving for mutual understanding, and facilitating a shared plan of care. Poor communication can lead to undesired outcomes, and effective communication is critical for optimal patient outcomes. The application of these communication competencies and the nature of the doctor-patient relationship vary for different specialties and forms of medical practice.*

To provide care that is high in quality, physicians establish an effective relationship with patients and other health care professionals. In order to establish such a relationship, it is essential that physicians possess communication skills that elicit patients' beliefs, concerns, and expectations about their illness. There are three types of patient-related communication skills: content, process, and perceptual.

Fundamental elements of effective communication include empathy, cultural sensitivity, respect for diversity, appropriate use of verbal and non-verbal communication, flexibility, and a non-judgmental approach.*

Objectives

  1. Appropriately develop and maintain ethical relationships, rapport and trust with patients, families and communities
    1. Initiate an interview with the patient by greeting with respect, attending to comfort and to the need for an interpreter if applicable, orienting to the interview, and consulting with the patient to establish the reason for the visit
    2. Use appropriate non-verbal communication (positioning, posture, facial expression)
    3. Tailor the interview to the clinical context (Emergency Department, clinic)
    4. Seek consent from competent patients before involving family members
    5. When appropriate, facilitate collaboration among families and patients, while maintaining patient wishes as the priority, ensuring confidentiality, and respecting patient autonomy
    6. Determine an appropriate substitute decision-maker, as required, and document appropriately

  2. Accurately elicit relevant information and perspectives from patients and families, colleagues and other professionals
    1. Elicit patient information through active listening and the appropriate use of open and closed questions, as well as using clear language appropriate to the patient's understanding
    2. Appropriately use interviewing skills such as clarifying, bridging, and summarizing
    3. Gather information about the patient's concerns, beliefs, expectations, and illness experience
    4. Receive relevant information from other sources such as the patient's family, caregivers, and other professionals and, with the patient's permission, seek out additional information

  3. Accurately convey relevant information and explanations to patients, families, and communities
    1. Respect patients' rights to be given complete and truthful information
    2. Identify the personal and cultural context of the patient, and the manner in which it may influence the patient's choices
    3. Provide information using clear language appropriate to the patient's understanding, checking for understanding, and clarifying if necessary
    4. Adhere to requirements for obtaining informed consent
    5. Effectively communicate in challenging situations (delivering bad news, addressing anger, confusion, medical error, misunderstanding and media interviews)
    6. In disclosing error and adverse events, do so in a prompt and truthful manner
    7. Disclose to the patient personal values or beliefs that may limit professional involvement

  4. Develop a shared plan of care with patients, their families, and other professionals
    1. Establish a common understanding and negotiate agreement concerning diagnosis, management, and follow-up
    2. Communicate clearly and effectively the reasons for referral and the consultant's responsibilities for patient care

  5. Effectively convey oral and written information associated with a medical encounter
    1. Effectively present information about clinical encounters and management plans to patients and their families
    2. Maintain comprehensive, legible, and up-to-date medical records, forms and reports, and retain those as required
    3. Allow patients access to their medical records and disclose to others only with the patient's consent or with appropriate legal authority (to family members, physicians or other health care providers, and to third parties)
    4. Maintain confidentiality of written and electronic records
    5. Write prescriptions correctly and legibly
      1. Adhere to legal requirements for writing narcotic prescriptions

  6. Communicate effectively with third parties other than health professionals
    1. Disclose patient information only when legally permitted
    2. Adhere to provincial or territorial requirements for obligatory disclosure of patient information (child abuse or abandonment, reportable communicable diseases, duty to warn threatened individuals)
    3. Transmit information to third parties (insurance companies, government agencies) truthfully and in a timely manner

* The Royal College of Physicians and Surgeons of Canada..