Speaking of values: the ethics of communication

The patient-doctor relationship is central to medicine. From this relationship, duties and obligations are derived; within this relationship, hopes and expectations are set. Communication is essential in this relationship and evidence-based efforts directed at improving it are a key element in improving care. At an even deeper level, critical reflection reveals fundamental values operating within and beneath this discourse that must be addressed if the goals of improving communication are to be achieved in a meaningful way. This is the stuff of the ethics of patient-physician communication. Because these values are so deeply embedded in the speech and actions of physicians, insights are best provided by those who are observers of the discourse rather than by participants. Observations from the history and sociology of physician communication, literary analysis and reflections on the illness experience by women provide important insights into the values and attitudes underlying physician communication, which must be taken into account in the education of physicians if the outcome is to benefit all participants.