Good communication is the bridge that spans the gap between the mind of the doctor and the patient. In this paper, the scope of the term communication skills has been broadened to include the knowledge, attitude and skills that enable a doctor to know and respond to the totality of the disease process as it affects the body and mind of the patient.

Communication is effective only when it is a two way process. Good communication draws upon knowledge of psychological, cultural, social, educational and economic influences upon the patient and disease. It requires that intellect and emotion be yoked together in the service of the alleviation of suffering and the promotion of health.

At the heart of the practice of medicine is a dynamic process seeking the best fit between the patient’s needs, the physician’s perception of the patient’s needs and what the physician has to offer. Fine tuning of this process requires knowledge of the patient’s values, attitudes and beliefs and therefore the social, cultural, religious and economic milieu of the patient. The ability to respond effectively is determined by the extent to which the doctor understands the working of the human mind, can discriminate between the subjective and objective aspects of human experience and can read between the lines of verbal expression.

The bed rock of good communication is the ability to ‘feel with’ the distress caused by the disease process. Once this ability is in place the trainee becomes motivated to fine tune communication and re-orient service towards a more patient centered approach. In the absence of the ‘feeling’ element , the ‘knowledge’ element of communication may never translate into action.

Special challenges in communication

While some basic rules of communication apply across cultures and continents, communication must be sensitive to individual variations. Culture, religion, social systems, and economic structure are some of the influences that determine the manifestations of disease and expressions of distress.

Socio-cultural variations

The economically deprived patient with little or no formal education does not come to the consultation alone. He is accompanied by his family or even members of his village unrelated to him. He is also accompanied by an invisible host of authority figures who influence his beliefs, attributions, preferences, values and hopes. The doctor ignores these at his own peril.