Relationship, Communication, and Efficiency in the Medical EncounterCreating a Clinical Model From a Literature Review

Department of Family Medicine, University of Washington, 4245 Roosevelt Way NE, Box 354775, Seattle, WA 98105, USA.
Archives of internal medicine (Impact Factor: 17.33). 08/2008; 168(13):1387-95. DOI: 10.1001/archinte.168.13.1387
Source: PubMed

ABSTRACT While there is consensus about the value of communication skills, many physicians complain that there is not enough time to use these skills. Little is known about how to combine effective relationship development and communication skills with time management to maximize efficiency. Our objective was to examine what physician-patient relationship and communication skills enhance efficiency.
We conducted searches of PubMed, EMBASE, and PsychINFO for the date range January 1973 to October 2006. We reviewed the reference lists of identified publications and the bibliographies of experts in physician-patient communication for additional publications.
From our initial group of citations (n = 1146), we included only studies written in English that reported original data on the use of communication or relationship skills and their effect on time use or visit length. Study inclusion was determined by independent review by 2 authors (L.B.M. and D.C.D.). This yielded 9 publications for our analysis.
The 2 reviewers independently read and classified the 9 publications and cataloged them by type of study, results, and limitations. Differences were resolved by consensus.
Three domains emerged that may enhance communication efficiency: rapport building, up-front agenda setting, and acknowledging social or emotional clues.
Building on these findings, we offer a model blending the quality-enhancing and time management features of selected communication and relationship skills. There is a need for additional research about communication skills that enhance quality and efficiency.

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Available from: Ronald M Epstein, Dec 13, 2013
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    • "In our study we had control over patient characteristics, including their hidden agenda, allowing us to investigate the relationship between its expression and EAGL-I scores. Early expression of the patient's full agenda has been linked with consultation efficiency and a reduction in late arising concerns [5] [7] [54] [55]. Our findings suggest that patient expression of their full agenda in the pre-teaching group is more likely to arise in response to specific skills. "
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    Patient Education and Counseling 07/2015; 98(10). DOI:10.1016/j.pec.2015.06.018 · 2.20 Impact Factor
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    • "Effective communication is considered to be an essential skill that clinicians need to master in clinical practice to improve quality and efficiency of care (Mauksch et al 2008). In order to promote effective communication, it is important that the clinician and patient co-operate and co-ordinate their communication (Street et al 2007). "
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    ABSTRACT: During the patient-therapist encounter, which communication factors correlate with constructs of therapeutic alliance? Systematic review. Clinicians and patients in primary, secondary or tertiary care settings. Studies had to investigate the association between communication factors (interaction styles, verbal factors or non-verbal factors) and constructs of the therapeutic alliance (collaboration, affective bond, agreement, trust, or empathy), measured during encounters between health practitioners and patients. Among the twelve studies that met the inclusion criteria, 67 communication factors were identified (36 interaction styles, 17 verbal factors and 14 non-verbal factors). The constructs of therapeutic alliance in the included studies were rapport, trust, communicative success and agreement. Interaction styles that showed positive large correlations with therapeutic alliance were those factors that help clinicians to engage more with patients by listening to what they have to say, asking questions and showing sensitivity to their emotional concerns. Studies of verbal and non-verbal factors were scarce and inconclusive. The limited evidence suggests patient-centred interaction styles related to the provision of emotional support and allowing patient involvement in the consultation process enhance the therapeutic alliance. Clinicians can use this evidence to adjust their interactions with patients to include communication strategies that strengthen the therapeutic alliance.
    Journal of physiotherapy 06/2012; 58(2):77-87. DOI:10.1016/S1836-9553(12)70087-5 · 3.71 Impact Factor
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    • "Next to this, Silverman (2009) advocates four other areas of integration in his landmark paper: integration with history taking skills, integration with specialty teaching, integration with the hidden curriculum through faculty training and assessment in integration. Students should also be trained in efficient communication (Mauksch et al. 2008; Malhotra et al. 2009). Acute settings should be simulated with purely somatic complaints next to simulated cases with emotional 'landmines' (Malhotra et al. 2009). "
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