Communicator | Medical Council of Canada
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As communicators, physicians effectively facilitate the patient-physician relationship and the dynamic exchanges that occur before, during, and after medical encounters.*


Physicians enable patient-centred 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 patient-physician relationship vary for different specialties and forms of medical practice.

To provide care that is high quality, physicians establish an effective relationship with patients and other health care professionals. 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 nonverbal communication, flexibility, and a nonjudgmental approach.


  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 nonverbal 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. Recognize how one’s own values/beliefs may bias how one approaches communication with patients and families
    2. Disclose to the patient personal values or beliefs that may limit professional involvement
    3. Respect patients’ rights to be given complete and truthful information
    4. Identify the personal and cultural context of the patient, and the manner in which it may influence the patient’s choices
    5. Provide information using clear language appropriate to the patient’s understanding, checking for understanding, and clarifying if necessary
    6. Adhere to requirements for obtaining informed consent
    7. Effectively communicate in challenging situations (delivering bad news, addressing anger, confusion, medical error, misunderstanding, and media interviews)
    8. Disclose error and adverse events in a prompt and truthful manner
  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. 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. Transmit information to third parties (insurance companies, government agencies) truthfully and in a timely manner
  7. Adhere to the ethical and legal requirements of confidentiality in all professional communication
    1. Maintain confidentiality of medical records.
    2. Know the exceptions to confidentiality and when it must or may be breached (e.g., duty to warn or report, child abuse, notifiable diseases)
    3. Recognize the duty to inform patients about mandatory disclosures
    4. Mitigate the risk of breaches to confidentiality posed by electronic communication (e.g., use of encryption, use of virtual private networks, verification of demographic information)
    5. Avoid inappropriate use of social media


Source: Adapted from “CanMEDS 2015 Physician Competency Framework” by the Royal College of Physicians and Surgeons of Canada, 2015. (