Listening to patients and responding with care: a model for teaching communication skills

Listening to patients and responding with care requires answering two simple but not so obvious questions: Does the clinician know how to listen? and Does the clinician know how to show patients that he or she cares? The initial task for the clinican is to learn to use listening skills to identify the way in which a patient is most comfortable interacting. Once this is accomplished, the clinician uses this information to move closer to where the pateint is comfortable communicating.

The framework for this model is the continuum of two intersecting axes. The horizontal axis poles are inquisitive and assertive. The vertical axis poles are objective and subjective. People who are most comfortable communicating in an inquisitive way and tend to be objective are called investigators. Those who are most comfortable communicating in an inquisitive way but are subjective in nature are called unifiers. People who are most comfortable communicating in an assertive way and favor subjectivity are called energizers. Those who are most comfortable communicating in an assertive way and tend to be objective are called enterprisers.

The progression of the typical medical interview, which involves gathering information, making decisions, addressing patient concerns, and discussing long-term outcomes requires the clinician to communicate in all four communication modes. Learning to identify how he or she is most comfortable communicating may help the clinician make a smooth transition from one mode to another.