Primary care physicians' understandings of patient-centred communication: A phenomenographic study

Patient-centred communication (PCC) is a key component of high-quality care. A persistent gap has been described between PCC as taught in classrooms and as enacted in clinical practice, often framed as a failure to transfer the skills taught. However, little is known about how physicians themselves understand PCC and how this shapes its enactment in everyday practice. Primary care is a particularly relevant setting for this question, given its central role in clinical communication training. The aim is to explore how primary care physicians (PCPs) understand PCC in clinical encounters.

A phenomenographic approach was used to explore variations in primary care physicians' understandings of PCC. Eighteen general practitioners and residents from primary care in Stockholm, Sweden, participated in semi-structured interviews, which were analysed iteratively to develop an outcome space comprising four hierarchically related categories.

Four different and inclusively related ways of understanding PCC were identified [1]: Pedagogical structure: PCC as a structured, instrumental process aimed at eliciting and answering patient questions and providing clear information [2]; Empathetic engagement: PCC as an emotionally attuned stance emphasising listening and validation [3]; Whole-person partnership: PCC as a collaborative decision-making that integrates patients' life contexts and values; and [4] Professional balance: PCC as an ethically grounded orientation balancing patient preferences, medical judgment, and responsible resource use.

PCPs understand PCC in four qualitatively different ways, from pedagogical structure to professional balance. While the first three categories broadly align with established PCC models, professional balance extends beyond them, highlighting ethical and practical tensions in everyday practice. These categories could inform educational design: systematically varying emotional intensity, contextual complexity, and value conflicts may help learners progress from structured technique toward professional balance in practice. Educational designs that offer repeated encounters with the same patient or simulated patient may build the trust needed for difficult conversations.