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ABSTRACT
Growing enthusiasm about patient-centered medical homes, fueled by the Patient Protection and Affordable Care Act's emphasis on improved primary care, has intensified interest in how to deliver patient-centered care. Essential to the delivery of such care are patient-centered communication skills. These skills have a positive impact on patient satisfaction, treatment adherence, and self-management. They can be effectively taught at all levels of medical education and to practicing physicians. Yet most physicians receive limited training in communication skills. Policy makers and stakeholders can leverage training grants, payment incentives, certification requirements, and other mechanisms to develop and reward effective patient-centered communication.
Physicians, medical organizations, and policy makers have become increasingly interested in the patientcentered medical home.1,2 The Patient Protection and Affordable Care Act of 2010 encourages pilot projects to test the model. Primary care practices that become medical homes will need to have a number of features and capabilities, ranging from electronic health records to care systems that support the coordinated management of chronic diseases. In addition, a well-designed medical home needs physicians who possess excellent patient-centered communication skills.3
There is growing recognition that the education and training of physicians should increase the focus on helping them acquire these capacities. In its June 2009 report to Congress, for example, the Medicare Payment Advisory Commission (MedPAC) recommended that Medicare payments for graduate medical education be linked to the development of such skills.4
As U.S. policy makers grapple with the implementation of health reform, it is appropriate to reflect on what we know about patient-centered communication skills and how they can be nourished. In this article we describe those skills and review their impact on patient outcomes. We demonstrate that patient-centered communication is more than simply being courteous and honest with one's patients; it is, in fact, a sophisticated process. We present evidence that communication skills can be taught and enhanced during the training of new physicians and through continuing medical education for practicing physicians, and we describe how proficiency in the skills can be assessed.
Finally, we observe that the development of patient-centered communication skills, like other requirements of patient-centered care, can and should be fostered through a variety of interventions by a broad range of stakeholders: medical educators, medical organizations, health care institutions, regulators, government...