Effective patient–doctor communication is the foundation for developing and maintaining successful therapeutic relationships. Communication is required at all stages of a general practice consultation,1–3 and is critical to the delivery of safe patient care.4 Consultation skills encompass communication skills, but also includes skills in structuring a consultation to ensure the best outcomes for patients. Consultation skills relate to areas such as identifying agendas, negotiating content, shared decision-making, time management and follow up. Ongoing education in communication and broader consultation skills is therefore essential for all general practitioners (GPs).5
Effective communication and consultation management benefit both the patient and the doctor. Good communication has been found to increase patient and doctor satisfaction and improve adherence to treatment, health outcomes and follow up. Patient-centred communication has also been found to decrease the likelihood of litigation and reduce consultation time.2,3,6 Communication failures can result in errors, misdiagnosis, inappropriate treatment, poor health outcomes and reporting/litigation.4
There is no single way GPs should communicate to be effective and build the patient–doctor relationship. Communication can take many forms, including verbal and non-verbal, and includes oral, written and body language. These need to be adjusted and tailored to each patient. Communication skills also need to be adapted to remote forms of consultations, such as telephone and video consultations.
Several guidelines have been developed through comprehensive research to establish a clear baseline for communication expectations.2 The Australian Commission on Safety and Quality in Health Care and the Australian Medical Association have released standards relating to safe and effective communication.4,7 The Medical Board of Australia's code of conduct also references the importance of effective communication.8
These guidelines suggest that effective communication requires a number of skills and attitudes, including, but not limited to:
- carefully listening to the patient, not interrupting and not rushing2
- being respectful and considering the patient’s unique psychosocial and cultural context and perspective2,3,6
- responding empathically, especially in socioemotional exchanges2,3
- asking open-ended questions to elicit additional issues or concerns from patients3
- using reflective listening strategies, such as summarisation and reflection, and regularly ‘checking back’ with patients to ensure understanding2
- providing clear and detailed information that is adapted to the patient’s level of health literacy and with consideration that English might be a subsequent language3
- being aware of non-verbal communication, including the GP observing their own and the patient’s body language, and encouraging the patient to talk by using cues, such as nodding.2,3
Awareness of the communication needs of Aboriginal and Torres Strait Islander peoples and people from other culturally and linguistically diverse backgrounds is essential for effective general practice consultation management. Communication with individuals with cognitive or sensory impairments and other vulnerabilities (eg mental illness or history of trauma) might also need to be adjusted to meet the patient’s specific needs. Maintaining a patient-centred communication approach, developing cultural awareness and competency, effectively using interpreters where appropriate and scheduling long appointments when required will allow GPs to manage consultations in a culturally safe and respectful manner.
GPs also need to communicate appropriately with family members and carers and ensure that they meet their duty of care responsibilities. This includes confidentiality, establishing appropriate consent and the provision of concise and meaningful information. Effective communication with other health professionals also facilitates continuity of care and optimises clinical outcomes for patients.9