In This Article Expand or collapse the "in this article" section Patient-Provider Communication

  • Introduction
  • History and Foundational Texts
  • Professional Organizations

Communication Patient-Provider Communication
Christopher J. Koenig, Wayne Beach
  • LAST REVIEWED: 22 September 2021
  • LAST MODIFIED: 22 September 2021
  • DOI: 10.1093/obo/9780199756841-0269


Patient-provider communication is the domain in health communication focused on the relationship between a clinical provider and the patient. Traditionally, research on patient-provider communication has focused on face-to-face interaction during clinical encounters, but more recent scholarship has expanded to include communication that occurs outside the clinical encounter, especially electronic communication modalities such as secure messaging between clinicians and patients. Patient-provider communication is of interest across multiple disciplines including medicine and medical education, sociology, anthropology, (socio)linguistics, and communication studies, among others. Clinically, effective patient-provider communication enables clinicians the ability to gather information, facilitate diagnosis, give instructions and advice with the goal of building and maintaining a strong therapeutic relationship, all of which are widely recognized as essential ingredients of high-quality care. Effective patient-provider communication has been associated with improved patient health outcomes that range from improved emotional health and overall functioning; biological health, including reduced pain, anxiety, blood pressure; and behavioral health, including increased adherence to recommended treatment, lower malpractice litigation, increased ability for self-management and for making medical decisions, and higher satisfaction with care. Because of these positive outcomes, communication skills are widely taught in both undergraduate and graduate medical education with an eye toward measuring improvement and modifying behavior over time. Methodologically, common approaches to studying patient-provider communication range from quantitative studies looking to explore relationships among context, participants, and communication; qualitative studies that seek to investigate personal experiences of health and illness and health care through the lens of communication; and mixed and multiple method studies that combine quantitative and qualitative studies or employ multiple research methods. Theoretically, patient-provider communication also adopts a wide focus. Topics range from the impact of authority in the form of knowledge and power asymmetries in the clinical encounter, how relationships and social support encourage or mitigate health outcomes and personal experiences of illness, and a naturalistic approach that prioritizes study of how clinicians and patients orient to, define, and create the clinical situation in real time. Overall, patient-provider communication is a robust area of research with both basic and applied significance.

History and Foundational Texts

The topic of patient-provider communication is foundational for a more encompassing and diverse field known as “health communication.” Early scholarship noticed the relationship between the communication process during clinical visits as one of the primary means for enacting health care and facilitating healing (Balint 1957). Early scholars came from diverse disciplinary backgrounds, including medicine as in Byrne and Long 1976 and Mishler 1984; psychiatry as in Kleinman 1980; sociology as in Starr 1982; and anthropology as in Kleinman 1980 and sociolinguistics as in Fisher and Todd 1983. Balint 1957 initiated the study of patients’ clinical problems in relation to their larger personal psychological and social issues. This monograph produced key insights, including a description of the relationship between how a clinician recommends treatment on a patient’s response and the idea that clinicians employ collective anonymity when referring to evidence and clinical knowledge. Byrne and Long 1976 focuses on the social processes involving distinct role identities of providers to outline a general structure, or phases, for acute medical visits in general medicine. Kleinman 1980 demonstrates that health beliefs, attitudes, and culture influence what counts as illness, health, and well-being by focusing on how traditional medicine and folk healers, and patients, enact their responsibilities. Conversely, Engel 1977 describes how contemporary medical practice operates within an exclusively scientific biological paradigm, biomedicine, that pays minimal attention to the significant influence of people’s psychological and social experiences where a new, alternative, and integrative bio-psycho-social paradigm is proposed. Starr 1982 provides a macro-sociological perspective on medical systems in the US, including medical visits, which he argues is integrally tied to the economic and political influence of physicians as powerful cultural authorities. Fisher and Todd 1983 and Mishler 1984 both examine the multiple relationships between language and communication as a critical factor in medical communication impacting patients’ experiences and healing outcomes. West 1984 draws attention to various complications and troubles inherent to clinical encounters. Collectively, these studies emphasize clinical visitations as social context for displaying medical authority and enacting health care. While historical, these contributions function as a foundation for studying patient-provider communication and continue to significantly influence not only our understandings of the past, but also how present and future clinical encounters get organized.

  • Balint, M. 1957. The doctor, his patient and the illness. London: Tavistock.

    DOI: 10.1097/00000441-195711000-00018

    One of the earliest studies of clinician-patient communication, this monograph documents authors’ experiences of the author and clinicians at the Tavistock Clinic in 1950s London. While the original focus was the influence of psychological factors on general medicine, the volume initiated the study of how patients’ clinical problems reflect personal, psychological, and social issues influencing symptom presentations and clinician-patient relationships.

  • Byrne, P. Sarsfield, and B. E. L. Long. 1976. Doctors talking to patients: A study of the verbal behaviour of general practitioners consulting in their surgeries. London: Her Majesty’s Stationery Office.

    This monograph was one of the first systematic studies of the primary care encounter. Using audio recordings of actual medical encounters, the authors noticed the regularities of visit organization and proposed distinct phases and the overall organization of primary care visits that set the stage for later work. This groundbreaking work is foundational for the study of provider-patient communication during medical visits.

  • Engel, G. L. 1977. The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.

    DOI: 10.1126/science.847460

    Contemporary medicine has given priority to the biological causes and treatments for disease across a population. This article questions how and why the exclusive reliance on biomedicine excludes other relevant aspects of disease, including patients’ illness experiences including psychological, behavioral, social, and even spiritual dimensions. This article fostered a major paradigm shift and offered a blueprint for research, teaching, and clinical work that seeks to integrate and coordinate bio-psycho-social-spiritual elements to achieve higher quality health care.

  • Fisher, S., and A. D. Todd, eds. 1983. The social organization of doctor-patient communication. Washington, DC: Center for Applied Linguistics.

    Linguistics played a significant role in early studies of patient-provider communication. This collection of essays brought together scholars whose focus is language-in-use, that is, how language is used in communicative processes. This volume emphasizes the multiple relationships between language as it is actually used and the larger social contexts in which language is constitutive. Many papers in this volume contributed key ideas that still inspire current scholarship.

  • Kleinman, A. 1980. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Vol. 3. Berkeley: Univ. of California Press.

    DOI: 10.1525/9780520340848

    Based on over ten years fieldwork in Taiwan and the United States, this volume examines the role of culture by comparing Asian traditional and contemporary American clinical practices. The book demonstrates that illness, disease, and the maintenance of health are embedded within larger sociocultural forces that create distinct “health care systems.” Comparative in focus, this study provides valuable insight into how providers and patients may utilize convergent and divergent explanatory models of disease and illness impacting treatment success and healing outcomes.

  • Mishler, E. G. 1984. The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.

    While not the first detailed study of provider-patient interactions, this monograph was influential in its argument that talk during medical encounters enacts the business of doctoring, presented as “the voice of medicine,” and of being a patient, presented as “the voice of the lifeworld.” This volume is valuable as a methodological treatise, an early empirical study, and a preliminary framework for constructing theories of patient-provider communication.

  • Starr, P. 1982. The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.

    This sociological study charts the social history of medicine within American society, documenting the structural and historical forces enabling individual physicians to organize themselves into a coherent profession exemplified by the American Medical Association (AMA). The study has particular importance for theorizing about physician power and authority, and especially the role of paternalism in provider-patient relationships. While this volume is valuable for describing the structural forces shaping medicine within the United States, it is also useful for comparative global studies across cultures and diverse medical systems.

  • West, C. 1984. Routine complications: Troubles with talk between patients and doctors. Bloomington: Indiana Univ. Press.

    The ordinary tasks of managing medical interviews, including time constraints and pursuits of medical agendas, can create conflicts impacting communication and quality of care. This book explores actions such as how doctors’ questions can dominate interactions, patients’ problems in providing answers, constraints on patients’ raising their emotional concerns, and a variety of “medical misfires” such as (mis)hearings, understandings, and the organization of laughter and social commentary.

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