Medical schools, professional societies, continuing medical education providers, office practice consultants, and others in local communities may offer skill-development resources. Physicians may want to ask their local organizations what they have available; if a number of physicians come together with an interest in a training program, this might prompt organizations to set up skill-development programs. Various books, articles, and websites are also available. What follows is a short list of organizations and resources that might serve as a starting point.
The Institute for Healthcare Communication (www.healthcarecomm.org) is a nonprofit organization, founded in 1987, with a mission to advance the quality of healthcare by optimizing the experience and process of healthcare communication. The IHC creates and disseminates educational programs and services.
Some of the IHC workshops are as short as half a day; others require several days, and may be spaced over a period of weeks or months. The following is excerpted from the write-up of one of IHC's popular workshops:
"Clinician-Patient Communication to Enhance Health Outcomes is offered as either a full day or half day workshop for groups with six to thirty participants. The workshop is a fast paced interactive program designed to provide participants with opportunities to practice skills and techniques, not simply hear about them.
"Participants work individually and in teams to analyze videotaped re-enactments of actual cases, reach agreement on what was and was not effective in the cases, and then create responses that would be more effective.
"In the last activity, participants work together to develop approaches to patients they are currently working with. Finally, participants are asked to choose one or two techniques that they can immediately use in their practice."
Another, more extensive IHC program, which helps participants develop skills to coach others, is described as follows:
"Coaching For Improved Performance consists of 24 instructional hours and is usually conducted in three consecutive days. The program uses a small group format with six to twenty-four members in a group. A faculty ratio of one faculty member to every four participants allows for considerable individual attention and for a high level of involvement for all group members.
"During the program, participants practice coaching strategies with one another and with clinicians from outside the training group. Standardized patients provide realistic scenarios and 'real time' coaching is practiced. Videotaped feedback provides each participant with an opportunity to see him or herself in the coaching role.
"Because of the emphasis on practice, participants have an opportunity to develop their own clinician-patient communication skills as well as develop coaching techniques."
IHC does not actually schedule workshops and courses itself, but it has regional coordinators and many trainers around the U.S. And the regional coordinators can help health plans, local medical societies, medical groups, medical schools, and even informal groups of individual physicians to set up workshops. A one-day workshop with adequate enrollment might be expected to cost each participating physician $100 to $200.
The American Academy on Communication in Healthcare (AACH)(www.aachonline.org) is a nonprofit organization with a mission of fostering best patient care by advocating a relationship-centered approach to healthcare communication, education, and research.
The organization provides institutional courses on topics that include enhancing effective communication, delivering bad news, and managing medical malpractice risk with improved communication skills. Health plans, local medical societies, medical groups, medical schools, and informal groups of individual physicians can contact AACH about setting up workshops.
AACH also offers doc.com, which is an interactive learning resource for healthcare communication (at www.AACHonline.org). Doc.com has a set of 41 online modules and more than 400 videos describing and demonstrating various aspects of physician-patient communication, actually showing interactions between real MDs and standardized patients. These videos are jointly produced by AACH and the Drexel University College of Medicine. Basic topics (with links to a few modules) include–
- Integrated patient-centered and doctor-centered interviewing-structure and content of the interview.
- Building a relationship
- Opening the discussion
- Gathering information
- Understanding the patient's perspective
- Sharing information
- Reaching agreement
- Providing closure
More advanced modules include–
- Responding to strong emotions
- Understanding difference and diversity in the medical encounter: communication across cultures.
- Giving bad news
- Domestic violence
- Drug abuse
- Discussing medical error
- Promoting adherence and health behavior change.
- Exploring sexual issues
- Exploring spirituality and religious beliefs
The module in the "Integrated patient-centered and doctor-centered interviewing" module, for example, shows the same doctor conducting an interview with two different approaches and obtaining a very different level of information and relationship with the patient depending on the approach. As the user views the interview online, a sidebar moves down the screen pointing out key elements of the interview and their effects. The objective of that module and accompanying materials is to bring the user to the point where he or she can-
- Describe the content, and process, of a "complete" medical history,
- Describe the difference between the tasks or functions of an interview and its structure,
- Describe patient-centered and doctor-centered interview goals and skills,
- Describe the different contributions of patient-centered and doctor-centered skills to understanding the patient's full (biopsychosocial) history,
- Describe the content and structure the written medical history.
At www.aachonline.org, anyone can try out the full set of Doc.com videos for 15 days for free.
The website also has an extensive bibliography on physician-patient communication.
And the website includes lists of articles documenting current deficiencies in practice, which AACH groups under such headings as–
- We interrupt patients in the earliest phases of the encounter.
- We fail to identify and prioritize patient concerns.
- We miss opportunities to understand and acknowledge patients' ideas and feelings.
- We fail to understand the importance of culture and ethnicity in health care
- We do not give bad news concisely and compassionately.
- We minimize patients' roles in their care.
- We underestimate patients' health literacy.
- We don't negotiate differences well with patients.
There are many other websites that have resources to help physicians improve communication. These include–