Canada is a leader in the development of physician-patient communication skills and patient-centred communication is the expected standard in every training program. Perhaps the most complete model is that from the University of Western Ontario: The Patient-centred clinical method (Stewart, M., et. al., 2003). Its six components are designed for primary care physicians but the principles apply to any physician act of communication. It is evidence-based, and most important, it makes clear that more than acquisition of communication skills is required.
Patient-centred care presupposes several changes in the mindset of the clinician. First, the hierarchical notion of the professional being in charge and the patient being passive does not hold here. To be patient-centred, the practitioner must be able to empower the patient, share the power in the relationship, and this means renouncing control which traditionally has been in the hands of the professional. This is the moral imperative of patient-centred practice. (Stewart, et. al, pp 5-6.)
How does one acquire such skills and, ultimately, attitudes? This system of teaching interviewing has been developed by the Standardized Patient Program (SPP) of the University of Toronto. It is used to help students at all levels understand the patient-centred method and to develop their language and communication skills.
It can be likened to a roadmap a physician might use to help navigate the landscape of the physician-patient conversation. Landscapes have features in common such as trees, meadows, perhaps a river, but each is also unique and there are many ways to navigate. We all view landscapes differently depending upon our previous experience. So it is with the physician-patient relationship. Depending upon the physician’s attitude and skills, they may use the roadmap effectively to get through the landscape of the conversation — or they may get lost. It is the physician’s obligation to see and understand the patient’s landscape, while noting important biomedical signposts.