Doctor-patient communication. Clinical implications of social scientific research.

Research in the social sciences has clarified the nature and problems of doctor-patient communication. The development of adequate communication skills is now a goal of training programs in the primary-care specialties. Social structural barriers impede effective communication, however, and information giving remains problematic. Doctors tend to underestimate patients' desire for information and to misperceive the process of information giving. The transmission of information is related to characteristics of patients (sex, education, social class, and prognosis), doctors (social-class background, income, and perception of patients' desire for information), and the clinical situation (number of patients seen). Doctors' nonverbal communication abilities are associated with outcomes of medical care such as satisfaction and compliance. Regarding the sociolinguistic structure of communication, doctors often maintain a style of high control, which involves many doctor-initiated questions, interruptions, and neglect of patients' "life world." Training programs and standards of clinical practice should emphasize that improved doctor-patient communication is both desirable and possible.