Background

The prevailing view in medicine that communication skills improve with practice and experience was challenged by the seminal studies published by Maguire and colleagues between 1976 and 1986. The traditional apprenticeship model of learning how to elicit information from patients was shown to have serious deficiencies. Few students managed to discover the patient's main problem or clarify its exact nature, let alone explore ambiguous statements, respond to cues or cover personal topics. Students who then underwent a training programme reported almost three times as much accurate and relevant information as the control group. A sub-sample of these students was followed up five years later to see whether their skills had persisted: both control and trained groups had improved, but the superiority in the skills associated with accurate diagnosis in the group given feedback was maintained. Both groups were poor at giving information, although this was something that these doctors were doing on a daily basis. Skills associated with information-giving had not in fact been taught to these doctors while they were undergraduates.

During the same period of time evidence was accumulating for the importance of effective communication, not only for participants in the consultation but also for the health service (see ‘Healthcare professional–patient communication’). For patients, effective communication was associated with enhanced satisfaction (see ‘Patient satisfaction’), enhanced adherence (see ‘Adherence to treatment’), and improved health outcomes. For doctors, effective communication was associated with reduced burnout, enhanced functioning and fewer complaints and litigation.