Everything you were afraid to ask about communication skills

'Communication skills' is now very well established in medical education as an area that needs to be taught at both undergraduate and postgraduate level. But it is a discipline with a low level of challenge--it allows itself constantly to take seriously questions about its fundamentals (such as whether it works at all) although common sense and everyday experience tell us that skills are indeed improved through training and practice. This slows progress. Much research has also concentrated on listing and defining a set of skills, yet although all doctors must understand and utilise a range of skills as a precondition for good communication, the findings themselves are often equally common-sensical, and are not, in any case, restricted to medicine. They often tend to form part of a general consensus in favour of lay-centredness, which has been studied in other types of professional encounter, particularly the language of teachers and pupils. Moreover, insofar as teachers of medical communication limit their aims and their own classroom language to terms associated with skills, they offer little scope for more important questions about how these skills should be deployed, and about the attitudes to medicine and professional life that underpin them. A central educational question is: should we concentrate on teaching skills in the belief that attitudes will follow, or attitudes in the belief that they will generate appropriate skills?