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REPLY

Dialogue: A Core Clinical Skill

F. Daniel Duffy, MD

1 August 1998 | Volume 129 Issue 3 | Pages 253-254

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IN RESPONSE:

Dr. Pocinki's frustration with the usual and seemingly standard push on physicians to see more patients per hour is completely understandable. Indeed, the present trend for shorter average visits for physicians not only exasperates, but demoralizes, the will to communicate with patients.

Yet, ultimately, when all types of patients are included in managed care plans, I think that patients will choose plans that encourage physicians to understand, counsel, and help them to make wise health decisions. When most patients enrolled in managed care plans are young and healthy, the counseling requested is minimal and the decisions often trivial. Thus, an internist's advanced interview skills are undervalued and even demeaned. As older patients with more complex problems enter managed care, their satisfaction will surely decrease if the time limits used for the generally healthy are applied. Some managed care organizations that insure all types of patients are currently investing in training programs to improve their physicians' communication skills.

There is no question that we internists must do the right thing for our patients. In so doing, however, we must clarify the difference between the encounter that requires minimal dialogue and the encounter that succeeds only through effective communication. If we insist that one form of physician-patient communication fits all, we could be accused of wasting time as the managed care organizations are accused of cheating time.

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American Board of Internal Medicine; Philadelphia, PA 19106

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