Chapter 1 emphasised how the principle of patient autonomy has become more central to the doctor-patient relationship while beneficence has concurrently diminished in importance because of its paternalistic overtones. Effective communication supports patient autonomy by enhancing understanding and is essential for good medical practice. It is the basis of history taking, obtaining consent for examinations and procedures, and explaining diagnoses and treatment. Effective communicators are able to establish rapport, trust and confidence with patients more easily, thereby enhancing the flow of crucial information and increasing the likelihood that advice will be heeded while decreasing the likelihood of acrimony or legal action if adverse events occur.1 Good communication skills alone are not sufficient, however-- they must be accompanied by clinical competence, compassion and ethical behaviour. Good communication skills are also a necessary prerequisite if the doctor is to demonstrate effective leadership of the 'health care team'.
Effective communication not only improves the quality of health care but in addition has a very positive effect on the satisfaction gained from a consultation by both the doctor and his/her patient. Breakdowns in communication are the basis of dissatisfaction in most patients. Surveys show that dissatisfied patients criticise their doctor for not listening, for not providing adequate explanations or for appearing uninterested. Satisfied patients perceive their doctor to demonstrate friendliness, understanding and an ability to anticipate or listen to their concerns.2,3 Failure of communication underlies the majority of complaints made against doctors (see Chapters 6 and 7). The autonomy of a patient is undermined when a doctor is a poor communicator or appears to be unapproachable or unwilling to respond to the patient's questions or concerns. A large proportion of the problems of a medico-legal nature which arise in clinical practice are generally precipitated by the latter factors.