Communicator

Definition

As Communicators, physicians form relationships with patients and their families* that facilitate the gathering and sharing of essential information for effective health care.†

Description

Physicians enable patient-centred therapeutic communication by exploring the patient’s symptoms, which may be suggestive of disease, and by actively listening to the patient’s experience of his or her illness. Physicians explore the patient’s perspective, including his or her fears, ideas about the illness, feelings about the impact of the illness, and expectations of health care and health care professionals. The physician integrates this knowledge with an understanding of the patient’s context, including socio-economic status, medical history, family history, stage of life, living situation, work or school setting, and other relevant psychological and social issues. Central to a patient-centred approach is shared decision-making: finding common ground with the patient in developing a plan to address his or her medical problems and health goals in a manner that reflects the patient’s needs, values, and preferences. This plan should be informed by evidence and guidelines.

Because illness affects not only patients but also their families, physicians must be able to communicate effectively with everyone involved in the patient’s care.

KEY CONCEPTS

Accuracy: 2.1, 3.1, 4.2, 5.1
Active listening: 1.1, 1.3, 1.4, 1.5, 2.1, 2.2, 2.3, 4.1, 4.3
Appropriate documentation: 2.1, 5.1, 5.2, 5.3
Attention to the psychosocial aspects of illness: 1.6, 2.1, 2.2, 4.1
Breaking bad news: 1.5, 3.1
Concordance of goals and expectations: 1.6, 2.2, 3.1, 4.3
Disclosure of harmful patient safety incidents: 3.2
Effective oral and written information for patient care across different media: 5.1, 5.2, 5.3
Efficiency: 2.3, 4.2, 5.2
Eliciting and synthesizing information for patient care: 2.1, 2.2, 2.3
Empathy: 1.1, 1.2, 1.3
Ethics in the physician–patient encounter: 3.2, 5.1
Expert verbal and non-verbal communication: 1.1, 1.4
Informed consent: 2.2
Mutual understanding: 1.6, 3.1, 4.1
Patient-centred approach to communication: 1.1, 1.6, 2.1, 3.1
Privacy and confidentiality: 1.2, 5.1
Rapport: 1.4
Relational competence in interactions: 1.5
Respect for diversity: 1.1, 1.6, 2.2, 4.1
Shared decision-making: 1.6, 4.1, 4.3
Therapeutic relationships with patients and their families: 1.2, 1.3, 1.4, 1.5, 1.6
Transition in care: 5.1, 5.2, 5.3
Trust in the physician–patient relationship: 1.1, 5.2, 5.3

Key competencies	Enabling competencies
Physicians are able to:
1. Establish professional therapeutic relationships with patients and their families	1.1 Communicate using a patient-centred approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion 1.2 Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety 1.3 Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly 1.4 Respond to a patient’s non-verbal behaviours to enhance communication 1.5 Manage disagreements and emotionally charged conversations 1.6 Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances
2. Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families	2.1 Use patient-centred interviewing skills to effectively gather relevant biomedical and psychosocial information 2.2 Provide a clear structure for and manage the flow of an entire patient encounter 2.3 Seek and synthesize relevant information from other sources, including the patient’s family, with the patient’s consent
3. Share health care information and plans with patients and their families	3.1 Share information and explanations that are clear, accurate, and timely, while checking for patient and family understanding 3.2 Disclose harmful patient safety incidents to patients and their families accurately and appropriately
4. Engage patients and their families in developing plans that reflect the patient’s health care needs and goals	4.1 Facilitate discussions with patients and their families in a way that is respectful, non-judgmental, and culturally safe 4.2 Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health 4.3 Use communication skills and strategies that help patients and their families make informed decisions regarding their health
5. Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy	5.1 Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements 5.2 Communicate effectively using a written health record, electronic medical record, or other digital technology 5.3 Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding

* Throughout the CanMEDS 2015 Framework and Milestones Guide, references to the patient’s family are intended to include all those who are personally significant to the patient and are concerned with his or her care, including, according to the patient’s circumstances, family members, partners, caregivers, legal guardian, and substitute decision-makers.

† Note that the Communicator Role describes the abilities related to a physician–patient encounter. Other communication skills are found elsewhere in the framework, including health care team communication (Collaborator) and academic presentations (Scholar).