PURPOSE: Compassionate and effective communication is critical in fostering the patient-physician relationship, with implications for patient satisfaction, clinical outcomes, medical errors, and litigation. Interpersonal and communication skills is one of the six ACGME core competencies. Historically, surgeons have a reputation for communicating more hastily and with less empathy than their primary care counterparts. Although prior studies have emphasized the need for additional surgeon training on interpersonal and communication skills, current communication skills curricula are not guided by evidence correlating specific communication skills with patient satisfaction. To inform the maturation of this curricula, we performed a systematic review to examine the aspects of surgeon communication that have a positive impact on patient satisfaction.
METHODS: We searched four major databases (PubMed, Embase, Scopus, and Ovid/Medline) in December 2020, with the search terms “surgeon,” “communication,” “interpersonal skills,” “interpersonal communication,” and “patient satisfaction.” Studies were limited to those published in English, assessing surgeons or surgical residents, evaluating interpersonal skills, and including patient satisfaction as an outcome. We excluded studies published prior to 2000 and those evaluating communication aids given to patients. Manuscripts were reviewed and coded for common themes.
RESULTS: Our initial search retrieved 1470 results. An estimated 679 duplicates were removed, resulting in 791 unique publications. After full-text review, a total of 26 papers met the inclusion criteria. The articles examined a broad range of physician specialties, including urology, otolaryngology, and general, breast, vascular, and orthopedic surgery. Three major communication themes were tied to patient satisfaction: (1) clear communication, (2) involvement of the patient, and (3) demeanor and interpersonal skills. Specific actions that supported clear communication included providing information at an appropriate level, explaining difficult terms and avoiding medical jargon, checking patient understanding throughout the conversation, and discussing crucial topics such as the risks of surgery, alternative treatment options, and postoperative care instructions. Interestingly, time spent showing patients their imaging (eg, CT, angiography) during the informed consent discussion did not result in increased patient satisfaction. When analyzing involvement of the patient, patient satisfaction scores were higher for surgeons who encouraged questions and provided adequate answers, initiated communication by asking the patient their opinion on various aspects of their condition and care, and helped the patient take control of their treatment decisions. Multiple studies found that increased patient involvement in treatment decisions correlated with increased satisfaction with care, even in patients who preferred less decisional control. Finally, with respect to surgeon demeanor and interpersonal skills, increased patient satisfaction occurred when surgeons gave appropriate greetings (eg, handshake, addressing the patient by name), appeared relaxed and not rushed, were attentive and made good eye contact, utilized self-disclosure when appropriate, and demonstrated culturally competent behaviors.
CONCLUSIONS: From this systematic review, clear communication, involvement of the patient, and surgeon demeanor and interpersonal skills are closely associated with patient satisfaction. Our findings inform evidence-based recommendations for areas of improvement for practicing surgeons. Furthermore, surgical residency programs may focus their training efforts on development of these aspects of interpersonal and communication skills that directly impact patient satisfaction.