Four Evidence-Based Communication Strategies to Enhance Patient Care


These communication skills will increase patient engagement and satisfaction without slowing you down.

Fam Pract Manag. 2018 Sep-Oct;25(5):13-17.

Author disclosure: no relevant financial affiliations disclosed.

The ability to communicate well is foundational to family medicine. Skillful communication helps family physicians establish relationships, solicit and share important information, and work effectively with patients, family members, and the public.1 However, when physicians are faced with the time pressures of a busy clinical work day, careful communication often gets lost in the shuffle. For example, a cross-sectional survey in the offices of 29 family physicians found that when soliciting patient concerns at the outset of a visit, physicians typically redirected patients' opening statements after a mean of 23.1 seconds.2 Once redirected, patients rarely return to their list of concerns, leading to unvoiced agenda items that are never addressed during clinic visits.2 Another study of 35 outpatient primary care visits found that some of patients' more common unvoiced agenda items include “worries about a possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context.”3 These unvoiced agenda items often lead to related problematic outcomes.3

As a physician, you want to do all you can to provide your patients with the care they want and need. Fortunately, evidence suggests that employing some relatively straightforward communication strategies can help your patients feel heard, encourage them to provide you with accurate and relevant information, and help you guide them through the complexities of the diagnostic process without derailing your schedule.


  • Through skillful communication, family physicians can help patients feel heard, encourage them to provide relevant and accurate information, and ease their fears and concerns about their health.

  • Evidence suggests that four communication strategies may help family physicians achieve these goals and improve patient satisfaction without significantly affecting the duration of a visit.


The simple act of sitting down can make a conversation feel less hurried, more open, and friendlier. In fact, evidence suggests that taking a seat with your patients (as opposed to standing) can improve patient satisfaction by improving patient perception of the visit. Although it is typical for physicians to sit for at least part of an office visit, hospital rounding often involves a hurried entry into the patient's room followed by a barrage of questions, updates, and plans for the day. (Indeed, most illustrations of hospital teaching involve the attending physician towering over a bed-bound patient, surrounded by a small army of students and residents, all standing!) Hospital room setups, isolation precautions, and hygiene concerns may encourage standing, but taking a minute to sit at


Dr. Cayley is a clinical professor with the University of Wisconsin School of Medicine and Public Health and the Prevea Family Medicine Residency in Eau Claire, Wisc.

Author disclosure: no relevant financial affiliations disclosed.


show all references

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2. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient's agenda: have we improved? JAMA. 1999;281(3):283–287.

3. Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000;320(7244):1246–1250. Erratum in: BMJ. 2000;321(7252):44.

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7. Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M. Reducing patients' unmet concerns in primary care: the difference one word can make. J Gen Intern Med. 2007;22(10):1429–1433.

8. McCulloch J, Ramesar S, Peterson H. Psychotherapy in primary care: the BATHE technique. Am Fam Physician. 1998;57(9):2131–2134.

9. Leiblum SR, Schnall E, Seehuus M, DeMaria A. To BATHE or not to BATHE: patient satisfaction with visits to their family physician. Fam Med. 2008;40(6):407–411.

10. Akturan S, Kaya ÇA, Ünalan PC, Akman M. The effect of the BATHE interview technique on the empowerment of diabetic patients in primary care: a cluster randomised controlled study. Prim Care Diabetes. 2017;11(2):154–161.

11. Pace EJ, Somerville NJ, Enyioha C, Allen JP, Lemon LC, Allen CW. Effects of a brief psychosocial intervention on inpatient satisfaction: a randomized controlled trial. Fam Med. 2017;49(9):675–678.

12. van Ravesteijn H, van Dijk I, Darmon D, et al. The reassuring value of diagnostic tests: a systematic review. Patient Educ Couns. 2012;86(1):3–8.

13. Rolfe A, Burton C. Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis. JAMA Intern Med. 2013;173(6):407–416.

14. Petrie KJ, Müller JT, Schirmbeck F, et al. Effect of providing information about normal test results on patients' reassurance: randomised controlled trial. BMJ. 2007;334(7589):352.

15. Traeger AC, Hübscher M, Henschke N, Moseley GL, Lee H, McAuley JH. Effect of primary care-based education on reassurance in patients with acute low back pain: systematic review and meta-analysis. JAMA Intern Med. 2015;175(5):733–743.

16. Bhise V, Meyer AND, Menon S, et al. Patient perspectives on how physicians communicate diagnostic uncertainty: an experimental vignette study. Int J Qual Health Care. 2018;30(1):2–8.

17. Epstein RM. Making communication research matter: what do patients notice, what do patients want, and what do patients need? Patient Educ Couns. 2006;60(3):272–278.


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