Abstract
Medical educators have promoted skillful communication as a means for doctors to develop positive relationships with their patients. In practice, communication tends to be defined primarily as what doctors say, with less attention to how, when, and to whom they say it. These latter elements of communication, which often carry the emotional content of the discourse, are usually referred to as interpersonal skills. Although recognized as important by some educators, interpersonal skills have received much less attention than task-oriented, verbal aspects. Moreover, the field lacks a common language and conceptualization for discussing them. This paper offers a framework for describing interpersonal skills and understanding their relationship to verbal communication and describes an interpersonal skill-set comprised of Understanding, Empathy, and Relational Versatility.
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Association of American Medical Colleges. The Humanism in Medicine Award, Annual Meeting, 2006. Available at:http://www.aamc.org accessed Feb., 2006.
Accreditation Council of Graduate Medical Education. ACGME Outcome Project. General Competencies. Available at http://www.acgme.org 2000. Accessed Nov., 2005.
Makoul G, et al. Essential elements of communication in medical encounters: The Kalamazoo consensus statement. Acad Med. 2001;76:390–3.
Braddock CH, Edwards KA, Hasenberg NM, Laidly TL, Leveinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999;282(24):2313–20.
Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on patient outcomes. J Family Pract. 2000;49(9):796–804.
Street RL. Analyzing communication in medical consultations: do behavioral measures correspond to patients’ perceptions? Med Care. 1992;30(11):976–88.
Engener B, Cole-Kelly K. Satisfying the patient, but failing the test. Acad Med. 2004;79(6):508–10.
Zoppi K, Epstein RM. Is communication a skill? Communication behaviors and being in relation. Fam Med. 2002;34(5):319–24.
Roter DL. Observations on methodological and measurement challenges in the assessment of communication during medical exchanges. Patient Educ Couns. 2003:50(1):17–21.
Makoul G. The SEGUE framework for teaching and assessing communication skills. Patient Educ Couns. 2001;45:23–34.
Boon H, Stewart M. Patient–physician communication assessment instruments: 1986–1996 in review. Patient Educ Couns. 1998;35:161–76.
Homboe ES, Hawkins RE. Methods for evaluating the clinical competence of residents in internal medicine: a review. Ann Intern Med. 1998;129:42–8.
Donnelly MB, Sloan D, Pymale M, Schwartz R. Assessment of residents’ interpersonal skills by faculty proctors and standardized patients: a psychometric analysis. Acad Med. 2000;75:S93–5.
Duffy FD, et al. Assessing competence in communication and inter-personal skills: the Kalamazoo II report. Acad Med. 2004;79(6):495–507.
Webster’s Seventh International Dictionary. Springfield, MA: G. and C. Merriam Co, Publishers; 1998.
Schachner DA, Shaver PR, Mikulincer M. Patterns of nonverbal behavior and sensitivity in the context of attachment relationships. J Nonverbal Behav. 2005;29(3):141–69.
Watzlawick P, Beavin JH, Jackson DD. Pragmatics of Human Communication. New York: Norton and Company, Inc; 1967.
Scheflen AE. The significance of posture in communication systems. Psychiatry. 1964;27:316–31.
Birdwhistell RL. Kinesics and Context: Essays on Body Motion Communication. Philadelphia: University of Pennsylvania Press; 1970.
Gladwell M. Blink. New York: Little, Brown and Co; 2004.
Ambady N, Laplante D, Nguyen T, Rosenthal R, Chaumeton N, Levinson W. Surgeons’ tone of voice: a clue to malpractice history. Surgery. 2002;132:5–9.
Coulehan JL, Block ML. The Medical Interview: Mastering the Skills for Clinical Practice. Philadelphia: FA Davis Co; 2006.
Goffman E. Behavior in Public Places. Glencoe, IL: The Free Press; 1963.
Hafferty FW, Franks R. The hidden curriculum; ethics teaching and the structure of medical education. Acad Med. 1994;69(11):861–71.
Haidet P and Stein HF. The role of the student–teacher relationship in the formation of physicians: the hidden curriculum as process. J Gen Intern Med. 2006;21:S16–20.
McLeod PJ, Tamblyn R, Benaroya S, Snell L. Faculty ratings of resident humanism predict satisfaction ratings in ambulatory medical clinics. J Gen Intern Med. 1994;9:321–6.
Hornblow AR, Kidson MA, Jones KV. Measuring medical students’ empathy: a validation study. Med Educ. 1977;11:7–12.
Winfield HR, Chur-Hansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34:90–4.
Dyche L, Zayas L. The value of curiosity and naivete for the cross-culture psychotherapist. Fam Proc 1995;35(4)389–99.
Fitzgerald FT. Curiosity. Ann Int Med. 1999;130(1):70–2.
Borell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice and scientific inquiry. Arch Fam Med. 2004;2(6):576–82.
Barondess JA. Viewpoint: on wondering. Acad Med. 2005;80(1):62–5.
Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75(4)269–76.
Epstein RM. Mindful practice in action (II): cultivating habits of mind. Fam Syst Health. 2003;21(1):11–7.
Richardson R. Keat’s notebook. Lancet. 2001;357(25):320.
Wear D, Nixon LL. Literary inquiry and professional development in medicine. Perspect Biol Med. 2002;45(1):104–24.
Berger JT, Coulehan J, Belling C. Humor in the physician–patient encounter. Arch Intern Med. 2004;164(8):825–30.
Charon R. Narrative medicine: a model for empathy, reflection and trust. JAMA. 2001;286(15):1897–1902.
McCauly J, Yurk RA, Jenckes MW, Ford DE. Inside “pandora’s box:” abused womens’ experiences with clinicians and health services. J Gen Int Med. 1998;13(8):549–55.
Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psychiatry. 2002:159:1563–69.
Shanafelt TD, West C, Zhao X, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559–64.
Novack DH, Suchman AL, Clark W, et al. Calibrating the physician: personal awareness and effective medical care. JAMA. 1997;278(6):502–9.
Macaskill A, Maltby J, Day L. Forgiveness of self and others and emotional empathy. J Soc Psychol. 2002;142(5):663–7.
Falicov CJ. Training to think culturally: a multidimensional comparative framework. Fam Proc. 1995;35(4):373–88.
Charon R. Medicine, the novel and the passage of time. Ann Int Med. 2000;132:63–8.
Larsen EB, Yao X. Clinical empathy as emotional labor in the patient–physician relationship. JAMA. 2005;293(9):1100–6.
Borell-Carrio F. The depth of a smile. Medical Encounter. 2000;15:13–4.
Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca, RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155(17):1877–84.
Candib L. What doctors tell about themselves to patients: implications for intimacy and reciprocity in the relationship. Fam Med. 1987;19:23–30.
Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287–90.
Kiesler DJ, Auerbach SM. Optimal matches of patient preference for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006;61(3):319–41.
Zinn WM. Transference phenomena in medical practice: being whom the patient needs. Ann Intern Med. 1990;113:293–8.
Branch WT. Viewpoint: teaching respect for patients. Acad Med. 2006;81(5):463–7.
Novack DH, Epstein RM, Paulsen RH. Toward creating physician-healers: fostering medical students’ self awareness, personal growth and well-being. Acad Med. 1999;74:516–20.
Epstein RM. Mindful practice. JAMA. 1999;282(9):833–9.
Beckman HB, Frankel RM. The use of videotape in internal medicine training. J Gen Intern Med. 1994;9:517–21.
Edwards A, Tzelepis A, Melgar T, et al. Fifteen years of a videotape review program for internal medicine and medicine-pediatrics residents. Acad Med. 1996;71(7):744–8.
Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ. 2005;37(2):145.
Schirmer JM, Mauksch L, Lang F, et al. Assessing communication competence: a review of current tools. Fam Med. 2005;37(3):184–92.
Hodges B, Turnbull J, Cohen R, Bienenstock A, Norman G. Evaluating communication skills in the objective structured clinical examination format: reliability and generalizability. Med Educ. 1996;30:38–43.
Hanna M, Fins JJ. Viewpoint: power and communication: why simulation training ought to be complemented by experiential and humanist learning. Acad Med. 2006;81(3):265–70.
Friedan RB, Goldman L, Cecil RR. Patient–physician concordance in problem identification in the primary care setting. Ann Intern Med. 1980;93:490–3.
Dyche L, Swiderski D. The effect of physician solicitation approaches on ability to identify patient concerns. J Gen Intern Med. 2005;20:267–70.
Thom DH, Cambell B. Patient–physician trust: an exploratory study. J Fam Pract. 1997;44(2):169–76.
DiMatteo MR, Hays R. The significance of patients’ perceptions of physician conduct: a study of patient satisfaction in a family practice center. J Community Health. 1980;6(1):18–34.
Eisenthal S, Emory R, Lazare A. “Adherence” and the negotiated approach to patienthood. Arch Gen Psychiatry. 1979;36:393–8.
Safran DG, Montgomery JE, Chang H, Murphy J, Rogers WH. Switching doctors: predictors of voluntary disenrollment from a primary physician’s practice. J Fam Pract. 2001;50(2):130–6.
Levinson W, Rotor DL, Mullooly JP, Dull VT, Frankel RM. Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277(7):553–9.
Fiese BH, Sameroff AJ, Grotevant HD, et al. (eds.). The stories that families tell: narrative coherence, narrative interaction, and relationship beliefs. Monographs of the society for research in child development. Malden, MA: Blackwell Publishers; 1999:64(2 serial No. 257).
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The author would like to thank Kim Marvel, Mary Catherine Beach, Larry Mauksch, and Richard Frankel for their helpful comments on the manuscript.
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Dyche, L. Interpersonal Skill in Medicine: The Essential Partner of Verbal Communication. J GEN INTERN MED 22, 1035–1039 (2007). https://doi.org/10.1007/s11606-007-0153-0
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DOI: https://doi.org/10.1007/s11606-007-0153-0