Patient-centered communication is the way clinicians and care teams listen, share information, and make decisions so that the patient's needs, values, and preferences are considered. Studies link it to better treatment adherence, fewer malpractice claims, and patients who understand their care plans. In this article, we’ll cover what it means, which basic skills make it work, and how everyone on the care team can practice it.
In this article:
- Why patient-centered communication treats the patient as a partner, not a recipient of instructions
- Patients of physicians who communicate poorly have a 19% higher risk of not following treatment
- Letting patients finish their opening statement, teach-back, and shared decision-making are fully learnable skills
- Medical assistants actually shape communication before and after the provider enters the room
What is patient-centered communication?
In simple words, patient-centered communication is communication that puts the patient's perspective at the center of care. The Institute of Medicine's definition of patient-centered care states it’s "respectful of and responsive to individual patient preferences, needs, and values" (1).
The most widely cited framework comes from Ronald Epstein and Richard Street, who wrote the National Cancer Institute's monograph on the topic. They describe six functions of communication in patient-centered care (2):
- fostering a healing relationship
- exchanging information
- responding to emotions
- managing uncertainty
- making decisions
- enabling patient self-management
As you can see, these functions overlap: a patient who feels heard shares more information, and a patient who understands the plan is better prepared to manage it at home.
Why does communication in patient-centered care matter?
Because it changes outcomes: a meta-analysis by Zolnierek and DiMatteo found that patients of physicians who communicate poorly have a 19% higher risk of nonadherence. When physicians received communication training, the odds of patient adherence were 1.62 times higher (3).
Communication also shows up in legal risk. In a classic JAMA study of primary care physicians, those with no malpractice claims spent longer with patients (18.3 vs 15.0 minutes), explained what would happen during the visit, and checked patients' understanding more often (4). Harvard's malpractice insurer CRICO found communication failures in 30% of the 23,658 cases it analyzed from 2009–2013 (5).
Then there's also health literacy: the last national assessment found that only 12% of US adults had proficient health literacy (6). The data is old, but the lesson still holds: most patients leave visits with less understanding than clinicians assume. That’s why open and transparent communication tailored to patients is worth its weight in gold.
What are some vital patient-centered communication skills?
While the basic skills are simple to describe, we all know they’re hard to do consistently under time pressure. The most important ones include:
Let patients finish their opening statement
Interruptions are common; we all know that. In a 1999 JAMA study, physicians redirected patients after an average of 23.1 seconds, and only 28% of patients finished their opening statement (7). A 2019 study in the Journal of General Internal Medicine found that clinicians asked for the patient's agenda in only 36% of visits. When they did ask, they interrupted in two-thirds of cases, after a median of 11 seconds. Patients who weren't interrupted needed a median of just 6 seconds to state their concern (8).
Ask open-ended questions
“What brings you in today?” gives the patient a chance to explain what’s going on in their own words. If you start with “Is the pain sharp?”, you’re already narrowing the answer down to yes or no. Let patients tell their story, and then ask more specific questions.
Respond to emotion
The NURSE model from VitalTalk gives five ways to respond: Naming, Understanding, Respecting, Supporting, and Exploring (9). Statements like "It sounds like this has been really frustrating" take a few seconds and often make the rest of the conversation more meaningful and successful.
Use teach-back
AHRQ describes teach-back as asking patients to state in their own words what they need to know or do. It tests how well you explained everything (10). "Just so I know I explained it clearly, how will you take this medicine at home?" works better than "Do you have any questions?"
Share decisions
AHRQ's SHARE approach breaks shared decision-making into five steps: Seek the patient's participation, Help them explore options, Assess their values and preferences, Reach a decision together, and Evaluate the decision later (11).
Use plain language
Sometimes it’s better to say "high blood pressure," not "hypertension," and "kidney" instead of "renal." Short sentences and one instruction at a time help patients of every literacy level.
How can the whole care team practice patient-centered communication?
It’s important to keep in mind that patient-centered communication starts before the provider walks in. The American Association of Medical Assistants notes that MAs help patients feel at ease and often explain the physician's instructions, including medications, special diets, and treatment procedures (12). AHRQ recommends that everyone who interacts with patients, nonclinical staff included, use teach-back (10).
At EnabliHealth, we train medical assistants in patient rooming and charting during orientation. Virtual medical assistants handle care-coordination calls, referrals, and inbox messages, where a clear, friendly explanation can prevent a missed appointment. When support staff take on these tasks, providers can spend more of the visit talking with patients – we dove deeper in our article on why care teams perform better at top of license.
What gets in the way of patient-centered communication?
While most barriers are practical, most also have practical fixes:
|
Barrier |
What helps |
|---|---|
|
Short appointment slots |
Set the agenda in the first minute; let MAs gather history and meds during rooming |
|
Eyes on the screen |
Face the patient while they talk; type after, or turn the monitor so they can see it |
|
Medical jargon |
Plain words, written summaries, teach-back |
|
Language differences |
Qualified interpreters instead of family members |
|
Strong emotion |
Name the emotion before giving more information |
Hospitals also have a measurable reason to address these barriers. The national HCAHPS survey scores communication with nurses, communication with doctors, communication about medicines, and discharge information as separate measures (13).
The takeaway
Patient-centered communication is vital to good care, and it costs less time than you'd think. Most patients need just a few seconds to say what's wrong, as long as nobody cuts them off. The rest comes down to checking that your explanation actually landed, and making sure everyone on the team, from the front desk to the MA, talks to patients the same way.
Sources:
- Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press, 2001.
- Epstein RM, Street RL Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, NIH Publication No. 07-6225, 2007.
- Zolnierek KBH, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care, 2009;47(8):826–834.
- Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA, 1997;277(7):553–559.
- CRICO Strategies. Malpractice Risks in Communication Failures: 2015 Annual Benchmarking Report. Risk Management Foundation of the Harvard Medical Institutions, 2015.
- Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006-483). National Center for Education Statistics, 2006.
- Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA, 1999;281(3):283–287.
- Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, et al. Eliciting the patient's agenda: secondary analysis of recorded clinical encounters. Journal of General Internal Medicine, 2019;34(1):36–40.
- VitalTalk. Responding to Emotion: Respecting (NURSE statements). vitaltalk.org
- Agency for Healthcare Research and Quality. Health Literacy Universal Precautions Toolkit, Tool 5: Use the Teach-Back Method. ahrq.gov
- Agency for Healthcare Research and Quality. The SHARE Approach: Essential Steps of Shared Decisionmaking. ahrq.gov
- American Association of Medical Assistants. Medical Assisting. aama-ntl.org
- Centers for Medicare & Medicaid Services. HCAHPS: Patients' Perspectives of Care Survey. cms.gov
