The article by Farrell and Kuruvilla1 in this issue of the Archives adds a novel and potentially helpful twist to solving a long-standing problem:
are there efficient ways that health care organizations can assess the quality of patient-clinician communication, provide feedback to clinicians, and subsequently improve clinical outcomes? Large health care organizations have tried to do this by systematically surveying patient satisfaction,2 and methods have been proposed for efficiently giving complex feedback about actual communication skills to clinicians.3 But what Farrell and Kuruvilla suggest—monitoring and grading performance on a single behavior at a time—could potentially prove to be workable on a large scale. It would be wonderful to have a replicable marker for good communication or a series of markers that could be applied over time and incorporated into a health care organization's routine feedback to clinicians. There may be many opportunities to gather this type of data for trainees, who are increasingly taking part in simulated patient encounters for various reasons. Doing it with practicing physicians could be more complicated but is not out of the range of possibility. This work could also lead to better training. Highly targeted, efficient programs might be more readily accepted and widely disseminated. What small set of skills, perhaps chosen by each trainee to match his or her style from among a set of similar skills,4 would have the most impact on long-term practice and patient outcomes?
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