Overview

The Institute of Medicine has released a discussion paper meant to encourage dialogue about the basic principles and expectations for communication between patients and providers.

As stated within the document, “whether considering risks and benefits or personal values and preferences, patients and clinicians each have unique and important information to contribute to understanding and deciding on prevention, diagnosis, or treatment options. Obtaining the highest-value care for each individual requires establishing common goals and expectations for care through shared deliberation that marshals the best information. Effective communication therefore requires clarity on patient and clinician roles, responsibilities, and expectations for health care; principles to guide the spirit and nature of patient-clinician communication; and approaches to tailor communication appropriately to circumstance (e.g., routine care, chronic disease management, life-threatening disease) and individual patient needs (e.g., health literacy and numeracy, living circumstances, language barriers, decision- making capacity).” (p.3)

Basic Principles and Expectations for Patient-Clinician Communication

Even though many factors contribute to the quality of the communication between patients and clinicians, this paper outlines 7 key expectations:

• Mutual respect, which encourages both parties to be engaged in the decision making process and recognition of the unique insights each brings to the discussion.
• Harmonized goals, which is a common understanding and agreement on the care plan.
• A supportive environment, for service provision and decision making.
• Appropriate decision partners, including clinicians with appropriate skills and patients/their advocates who are able to communicate their understanding.
• The right information, which includes the clinician sharing the best available evidence at hand along with presentation of choices and tradeoffs and patients sharing relevant perceptions, symptoms and personal practices.
• Transparency and full disclosure, which acknowledges limitations in science and health care system and patient openness to sharing relevant circumstance and medical history.
• Continuous learning, which establishes regular opportunities for feedback on progress.

How can this paper stimulate dialogue?

Following an explanation of the principles above, this paper includes questions for various stakeholders (clinicians, systems, patients/advocates, professional societies and others) to consider as they examine their communication approaches.

Citations

Paget L, Han P, Nedza S et al. Patient-Clinician Communication: Basic Principles and Expectations. Institute of Medicine. June 2011. http://iom.edu/Activities/Quality/~/media/Files/Activity%20Files /Quality/VSRT/PCCwLogos.pdf