Communication challenges for experienced clinicians: topics for an advanced communication curriculum.

We asked 111 experienced clinicians (MDs, RNs, PhDs, DMins) attending a conference on medical interviewing for descriptions of communication challenges they encountered while practicing in clinical health care settings. Eighty-one provided accounts analyzed in this study. Using narrative analysis, we found that most of the accounts focused on conflicts between clinicians and patients based on differing beliefs about the nature and treatment of illness and contrasting expectations about the doctor-patient relationship. This article traces the clinician-narrators' use of plot, characterization, cause-effect relationships, and idealized images to make sense of challenging communication encounters. The results of our analysis point to several communication competencies that experienced clinicians found they lacked, even af ter receiving communication training and developing an awareness of the literature on teaching health communication skills. Building skills in the identified areas could reduce clinician frustration and enrich the practice of medicine.