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AANS Neurosurgeon | Volume 28, Number 2, 2019


Science of Physician-Patient Communication

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“Would you trust a surgeon who told you ‘I haven’t had any formal training for this procedure, observed any experts nor received feedback on my skills, BUT over the course of time, through trial and error, I think I’ve found what works for me’?” 1

Dr. Calvin Chou posed this critical question in his article on the importance of physician communication skills. As a resident educator, this quote struck a nerve. We are taught that our knowledge and technical skills are key to patient care. We spend hours reading, memorizing and practicing. Certainly, patients want to know that we have the skill to care for them. But, is that all? Where in neurosurgical education do we formally teach communication skills? Despite being a core competency of the neurosurgical milestones, communication is rarely taught in a systematic way.

Communication and patient satisfaction have been hot topics in recent years. Since 2012, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results have directly impacted hospital reimbursement. Hospital-employed physicians have likely been subject to a newsletter, grand rounds or workshop on communication skills aimed at increased patient satisfaction and therefore improved reimbursement. But, is that the only reason it matters? What does the science tell us?

Studies have found implementation of communication techniques lead to improvements in patient outcomes. It may not be surprising that patient satisfaction and other subjective measures (e.g. pain) improve when patients feel a connection with their physician.2 However, improvement in quantitative outcomes, such as cholesterol levels, Hemoglobin A1c and post-heart attack mortality have also been reported.3,4 Compliance with treatment recommendations also improves with enhanced communication.5 More than once, I have seen a patient after surgery and smacked my forehead thinking, “Why didn’t she follow my instructions?” and never stopped to question where I went wrong during peri-operative counseling. 

If communicating well with our patients is of such importance, communication skills workshops should be as well-attended as cadaver labs. Yet, surgical emergencies seem to always arise just as that mandated communication course is getting started. Admittedly, a further dive into the literature reveals the effect size of physician communication skill on outcome to be modest. So too is the effect size of aspirin on heart attack mortality2, but we do not question the imperative to administer it. 

As surgeons, we have become adept at discussing treatment plans and the details of a surgery, the communication of professional information. However, we spend little time addressing the concerns and feelings that these situations invoke6 probably because we believe that really talking with patients takes too much time. Who hasn’t thought they completed an encounter only to have a patient say, “Can I ask you one more thing?” as you grab the door handle? Specific communication strategies, such as agenda setting and responding to emotional cues, have been shown to improve both patient satisfaction AND physician efficiency and can be taught effectively to a wide spectrum of practitioners.7,8

As an added bonus, physicians who demonstrate key communication skills have lower rates of burnout.9 So, improving communications skills turns into a win-win-win situation (patients-physicians-institutions).

Training residents must extend to the realm of physician communication – there is clear science that communication impacts practice in crucial ways. Neurosurgery can and should take the lead to insure that the future of medical education will place an emphasis on competence in communication skills.


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1. Chou, C. (2018). Time to Start Using Evidence-Based Approaches to Patient Engagement. NEJM Catalyst. Retrieved from

2. Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE, 9(4).

3. Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians? Empathy and Clinical Outcomes for Diabetic Patients. Academic Medicine, 86(3), 359-364.

4. Meterko, M., Wright, S., Lin, H., Lowy, E., & Cleary, P. D. (2010). Mortality among Patients with Acute Myocardial Infarction: The Influences of Patient-Centered Care and Evidence-Based Medicine. Health Services Research, 45(5p1), 1188-1204.

5. Zolnierek, K. B., & Dimatteo, M. R. (2009). Physician Communication and Patient Adherence to Treatment. Medical Care, 47(8), 826-834.

6. Levinson, W., Hudak, P., & Tricco, A. C. (2013). A systematic review of surgeon–patient communication: Strengths and opportunities for improvement. Patient Education and Counseling, 93(1), 3-17.

7. Brock, D. M., Mauksch, L. B., Witteborn, S., Hummel, J., Nagasawa, P., & Robins, L. S. (2011). Effectiveness of Intensive Physician Training in Upfront Agenda Setting. Journal of General Internal Medicine, 26(11), 1317-1323.

8. Levinson, W. (2000). A Study of Patient Clues and Physician Responses in Primary Care and Surgical Settings. Jama, 284(8), 1021.

9. Krasner, M. S. (2009). Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. Jama, 302(12), 1284.


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