Changing Clinician Behavior: Necessary Path to Improvement or Impossible Dream?

• Patient satisfaction
• Physician-patient relations
• Communication
• Health services research

Because the outcomes of many clinical interventions are influenced by the quality of clinician-patient communication, improving communication skills is an important goal. Studies have demonstrated that the quality of communication in clinical encounters also affects the likelihood that patients will use medications correctly and will follow other treatment recommendations.

In this issue, Brown and colleagues (1) describe a randomized trial to improve the communication skills of primary care and subspecialist physicians, surgeons, physician assistants, and nurse practitioners. During the trial, 37 of 69 clinicians in Kaiser Permanente Northwest Division were randomly assigned to participate in a communication skills training program. The authors measured the effect of the program by sending a survey to patients who had had recent ambulatory care visits. Participating clinicians believed that the program improved their communication skills, but patients' assessments of clinicians in the intervention group and those in the control group showed no difference in degree of improvement

Substantive, design, and statistical factors may help explain these negative results. One should always consider the appropriateness of the outcome measure. In this study, for example, it is possible that direct observation of communication skills, rather than patient surveys, would have shown a difference between the two groups of clinicians. However, Brown and coworkers used a survey whose questions had high face validity and assessed the behaviors that the intervention was designed to influence. Furthermore, if clinician communication changed but patients …