Difficult Conversations in Medicine
Good communication is the solution, or part of the solution, in nearly every difficult interpersonal situation, whether between husband and wife, supervisor and employee, student and teacher, or patient and physician. In medicine, good communication is necessary for the establishment of a therapeutic alliance between patient and physician. Through good communication, physicians come to appreciate patients' values and expectations, which, in turn, inform treatment recommendations that are better understood by patients, and that understanding ultimately contributes to greater adherence to treatment and improved health outcomes. This is not to say that such conversations are easy, even for experienced physicians, or that they come naturally to most medical students and residents—communication skills must be learned and practiced. The need to practice—to use—communication skills is, in part, why the educational technology of the standardized patient is a common feature of today's medical school curriculum and has slowly gained acceptance in residency training and beyond. This month's issue features vignettes and practical commentaries that aim to support the educational goal of helping students and physicians become better talkers and listeners.