Fifth Edition (2006)

John Coulehan and Marian Block

F.A. Davis Company, 409 pages

Overall rating: Sadly flawed

Strengths: Offers a good breadth of practical skills to apply to the medical interview

Weakness: Uses clinician to clinician communication as a basis of understanding patient to clinician communication

Audience: Junior Medical Learners

The Medical Interview is a commonly used book for teaching junior medical learners the basic methods of interviewing patients.  It contains a wide variety of well explained skills in regards to variety of aspects of communication with patients.  It has good advice in regards to adolescents, geriatrics, cultural competence and breaking bad news. In particular, its descriptions of the empathic cycle and empathic levels of responding are excellent.  Categorizing responses as ignoring, minimizing, interchangeable and additive gives learners a comprehensible framework of how to respond to patients’ feelings and emotions rather than with rote statements such as “I’m sorry,” or “that must be very difficult.”

Despite the plethora of excellent content contained within The Medical Interview, Coulehan and Block make the same tragic mistake of organizing the interview based clinician to clinician communication rather than clinician to patient communication.  The major sections of the text are components of the case report which gives the mistaken impression that medical interviews should flow based on that paradigm rather than the freer flowing and messier interaction that patient centred interviewing requires.  I worry that following this text would make learners’ interviews far more rigid as they try to keep with this set structure.  This book is also challenging to use from a curricular perspective.  There is no attempt to provide a bird’s eye model of communication that can be easily remembered and diagrammed.  Its content, while organized, is not layered in a way to facilitate recall.

I think the numerous ideas contained within The Medical Interview has value as a reference text but not as the framework to understand the medical interview.  I would discourage learners from using this as a structure to understand how to communicate with patients as its methods can potentially lead to the flawed communication style frequently seen within health care.  I believe undergraduate medical curricula are better served by utilizing other texts.

Second Edition (2005)

Suzanne Kurtz , Jonathan Silverman, Juliet Draper

Radcliff Publishing, 369 pages

Overall rating: Epic

Strengths: Foundational piece of literature that informs the organized teaching and learning of patient-physician communication

Weakness: Neglects the patient centred content of the interview

Audience:  Clinician-teachers and communication program directors

Teaching and Learning Communication Skills in Medicine is the companion book to Skills for Communicating with Patients.  It takes the theoretical constructs used to understand the clinician-patient interaction and shows how to teach and learn them.  The book starts at the basics examining the why, how and what to teach and moves to progressively more complex areas.  Subjects span:

• Creating structure for learners
• Running small groups session
• Providing feedback
• Utilizing technology
• Developing a communications curriculum
• Supporting faculty in a communication curriculum

The authors use a rich array of educational theory to support the ideas they advocate.  In particular, they draw about Kolb’s ideas about experiential learning to underlie their thesis.  The most interesting idea they advocate is flipping the skills used for clinician-patient interaction to parallel and direct clinician-learner interactions.  This book balances well the theoretical aspects with practical and easily implementable teaching methods.

The only short comings of Kurtz et al’s ideas lie in the same challenges of their original book – the lack of attention given to patient-centred content.  Nonetheless, this book is excellent.  I feel using the knowledge contained within its pages will significantly enhance my teaching methodologies and ability to write curriculum.  I think this book would be extremely valuable for all clinician-teachers and is a must read for all communication course directors.

Third Edition (2013)

Jonathan Silverman, Suzanne Kurtz, Juliet Draper

Radcliff Publishing, 305 pages

Overall rating: Mind-blowing

Strengths: Foundational piece of literature that transforms patient-physician communication into a learnable set of skills

Weakness: Neglects the patient centred content of the interview

Audience: Clinicians, clinician-teachers and medical learners who wish to improve their interactions with patients

Unlike clinician-clinician communication, the patient-clinician interaction is messy.  Clinicians have many years of training that allow colleagues to communicate to each other using specialized terminology and structures that enable fast, meaningful and deep conversations.  Patients do no have these structures and communicate based on the vantage point of their illness experience.  It is our roles as clinician to be able to listen and provide structure to enable patients to communicate their entire story while ensuring the patient feels heard.  Unfortunately, the structure of the clinician-clinician interaction (the case report – ID, CC, HPI, PMHx, Meds, etc…) has become the basis of teaching communication with patients.

Silverman et al re-examines the patient-clinician interaction by discarding the traditional case report as basis of understanding this interaction.  This piece correctly identifies the three major themes that need to be addressed to understand how physicians communicate with patients:

• Content skills – what information needs to be conveyed
• Process skill – how the information is communicated
• Perceptual skills – what the clinician is thinking while communicating

An overarching framework is given to understand these skills is given through the Calgary-Cambridge Guide to enable these skills to be committed to memory.  Silverman et al go into depth exploring over seventy easily understood process skills that broadly break down into initiating the interview, gathering information, physical examination, explanation and planning, closing the session, providing structure and finally building the relationship.

Overall this book is excellent.  It provides structure to the chaotic interview.  Many of the skills contained within the pages I have been doing already but many I have not.  Reading this piece will significant improve my communication with patients.  The major fault of the methods proposed is lack of patient-centred content.  While this book has considerable overlap with Stewart et al’s work in Patient-Centred Medicine, it mostly ignores the non-medical patient context (ie. determinants of health).  The Calgary-Cambridge teaching tools can be significantly strengthened by the addition of patent centred content. While I believe together Skills for Communicating with Patients and Patient-Centred Medicine can form the foundation of any communication curriculum, neither is inclusive enough to stand on its own.