Clinical Review & Education
JAMA Insights | COMMUNICATING MEDICINE
Delivering Effective Messages in the Patient-Clinician Encounter
Joseph N. Cappella, PhD; Richard L. Street Jr, PhD
Effective communication between patient and clinician is a core
function of the medical encounter.1 In a survey of cancer survivors,
communication breakdowns most often identified by respondents
were failures of information exchange, both in information provided
by the clinician (eg, too complex, not enough) and in missing infor-
mation from the patient or fail-
ing to elicit it.2 These failures can
Editorial
be medically significant, affect-
ing adherence to prevention,
CME at jamacmelookup.com screening, and treatment; under-
mining the patient-clinician relationship; increasing anxiety and con-
fusion; exacerbating health disparities; and accepting misleading, in-
complete, or false medical information from ill-informed sources.
Clinicians have 4 communicative responsibilities to ensure
shared and accurate understanding with their patients: (1) uncover
what the patient understands and why, (2) provide accurate infor-
mation in an understandable way, (3) promote the credibility of the
information, and (4) check for shared understanding. The Table pro-
vides specific examples of what clinicians can (and should not) do
to accomplish these goals.
Uncover Patient Beliefs and Knowledge
Creating a trusting and respectful relationship with patients is the
basis for effective communication. Eliciting the patient’s perspec-
tive, health beliefs, assumptions, concerns, needs, and stories is criti-
cal to every clinical discussion. A person’s conception of health, ill-
ness, and treatment can be complex and determine what kinds of
testing, treatments, and outcomes they expect and feel are appro-
priate. Communicative strategies that encourage disclosure in-
clude building partnership (eg, “What concerns do you have?”), so-
liciting the patient’s agenda, and eliciting the patient’s perspective
(eg, “So what do you think is going on?”). Using open-ended ques-
tions and letting the patient speak without interruption at the on-
set are important strategies. Checking that one accurately under-
stands the patient (eg, “So what you’re saying is…”) ensures that what
is said is heard and properly interpreted. Knowing the patient’s per-
spectives provides insight into how to address the patient’s con-
cerns and needs by understanding the what and why of their be-
liefs and values.3 Basic probing of the patient’s perspective can guide
the content and form of subsequent discussions.
Provide Accurate and Understandable Information
Althoughthedemandsonphysicians’time,patience,andworkloadare
severe, conventional advice to clinicians such as “just give them the
facts” is not enough. Research has shown that although medical facts
need to be the basis for the clinician’s core message, those facts are
more effectively communicated in a patient-clinician relationship char-
acterized by trust and cooperation and when the information is pre-
sented in a manner that fosters patient understanding. This includes
ensuring that interpreters are used for patients who are not fluent in
theclinician’slanguageandusingcomplementarymethodsofcommu-
nication from simple written information, pictures, and videos.
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Promote Credibility of Information
Patients typically believe the information their physician provides,
and most patients consider their physicians to be trusted sources
for health information.3 However, trust in the information pro-
vided involves more than scientific facts. Trust is based on a judg-
ment that the physician has the patient’s best interests at heart. Pa-
tients may be suspicious of the information when it runs counter to
their own belief systems, personal experience, or cultural history or
because of mistrust of the medical profession.4 Patients are less
forthcoming and more resistant to explanations and recommenda-
tions when they feel they are misunderstood, judged, discrimi-
nated against, or suspicious of the information or recommenda-
tions. Physician credibility is granted from their expertise, but is also
earned through sincere expressed interest in the patient’s welfare.
Can the facts be communicated so that they are engaging, com-
prehensible, memorable, and accepted? Yes, empirically sup-
ported strategies include affirming the patient’s values, anticipat-
ing and addressing false or misleading information, using simple
jargon-free language, and embedding the facts in a story rather than
a dry recitation of the science. Conveying factual material using these
techniques make facts more engaging and memorable. Presenting
them in the context of a patient’s expectations, assumptions, and
beliefs can enhance understanding and satisfaction and support self-
care behavior. Embed information in the patient’s values, warn them
about pseudo-facts in advance, and tell it all in a preferably per-
sonal, but simple, story.
Value affirmation activates and appeals to the patient’s values
first, before providing fact-based potentially threatening guid-
ance. Acceptance of threatening or frightening information is im-
proved when received in the context of the patient’s accepted core
values or moral principles. Research across cultures shows remark-
able similarity in the kinds of and priorities for values. Safety and se-
curity for oneself and loved ones and care for others are widely shared
and prioritized. Value affirmation is a kind of “spoonful of sugar” that
can help the medicine go down.5 Affirming values also contributes
to cooperative rather than oppositional relationships.
Prebunking is a strategy of inoculation (to use a medical anal-
ogy) against the disease of false or misleading beliefs and informa-
tion. The basic principle is that a small dose of a “virus” (reminding
the patient about misleading information while countering it) can
breed “antibodies” conferring mental resistance to more “virulent”
later forms (egregious lies).6 Prebunking is less effective for very well-
established beliefs, but more useful for patients likely to become ex-
posed in the future to information contrary to scientific fact (eg, false
information about the human papillomavirus or measles-mumps-
rubella vaccine regimens). Prebunking works best when one can ac-
curately anticipate what types of false information the patient finds
compelling and may be exposed to. It does not replace eliciting
patients’ fears and misconceptions and addressing them directly
and respectfully.
Everyone likes a good story. Narratives can be more readily com-
prehended, more engaging, relationally rich and personal, and, in fact,
(Reprinted) JAMA Published online February 1, 2024 E1
 Clinical Review & Education JAMA Insights

Table. Goals and Strategies for and Examples of Effective Patient-Clinician Interactions

Goal Strategy Example

Relational mindset
Foster Patient’s interests “I’m running late. Sorry. Couldn’t be helped but now my time is all yours.” NOT “I’m running late. Sorry. What a day I’ve had!
cooperation primary I’ve been buried.”
and trust Avoid blaming, judging, “Changing behavior is tough. Let’s talk about some ways to move forward.” or “Tell me what has worked for you.”
and stigmatizing NOT “You need to take control and make the change. It’s your choice to do or not.”
Communication strategies
Uncover Solicit patient’s agenda “What concerns bring you in today?” (Open-ended question) NOT “Let me check on what I asked you to do the last time.”
Encourage disclosure “Let’s explore that last issue in more detail. What do you think is going on?” DO NOT assume what the patient is experiencing;
dismiss or complete the patient’s comment; interrupt.
Solicit patient’s point “So you’re concerned about the … Tell me more about that.” NOT “No, that’s not right. There is no evidence for that.”
of view
Provide Provide accurate “The best medical science today usually requires …” or “There are pros and cons. Let’s explore the benefits and harms
information honestly.” NOT “The test numbers don’t lie. They can only mean one thing.”
Provide understandable “The report is full of doctor talk. Let me tell you what they mean in plain language.” NOT “Once the antigen-specific antibodies
information are produced, they work with the rest of the immune system to destroy the pathogen.”
Promote Affirm values “Your loved ones need you to be the healthiest you that you can be …” or “You take care of your family, and part of taking care
of them is taking care of you” NOT “You need to get your priorities straight” or “No, what should be important to you is….”
Prebunk inaccurate Prebunk the information, not the people: “Some false rumors have circulated locally about … Here’s the facts” or “here’s what
information we know.” NOT “There are a lot of ignorant and dishonest people promoting the idea that….”
Use stories, especially “When someone close to me had to deal with a similar condition …” or “ I had a patient who….” NOT “If you want to be sure,
personal I can send you to the medical journals for more.”
Check Confirm shared “So, would this approach work for you?” or “This can be confusing. I want to be sure that I explained it clearly. Please tell me
understanding what your understanding is.” or “And our next steps will be….” NOT “So that should be clear to you now” or assume patient
understands when they don’t ask questions.

more persuasive than didactic recitations. Stories enhance mental en-
gagement with the content, ready identification with characters, and—
when the story is a personal one (eg, “when I was caring for my own
mother…”)—elevate trust.7 Clinicians therefore should listen care-
fully to a patient’s own stories to more fully understand how best to
engagethemandframemedicalinformationinacomplementarystory.
Stories can also reframe information into a different way to think
about an issue. For example, COVID-19 vaccines were mistrusted by
many because of their rapid development. Alternative stories ac-
knowledged speediness while reframing the events to a narrative
in which the core methodology had a long history and, when coupled
with unprecedented investment by government-pharmaceutical
partnerships, speedy development ensued. Stories gain attention,
are understood, and appeal across the demographic spectrum. Em-
bedding information in a story can make it more comprehensible and
compelling, leading to greater acceptance of the information em-
bedded in the story.
Check for Understanding
Effective communication builds in redundancy and quality control.
Clinicians may believe that they and the patient share the same un-
derstanding and assumptions about the information, but effective
communication requires verification of comprehension, especially
on key information. Techniques such as teach back (eg, “To be sure
I explained clearly, could you tell me what you have understood
so far”)8 and asking for questions allow checking. Although written
summaries can be useful, direct interaction allows immediate feed-
back of success or failure and on-the-spot correction.
Conclusions
Some simple communication strategies used by clinicians can en-
hance accurate information gathering and exchange, encourage
patient engagement, enhance comprehension, ensure retention of
the information, and advance acceptance. Effective communica-
tion takes deliberation and practice.

ARTICLE INFORMATION
Author Affiliations: Annenberg School for
Communication, University of Pennsylvania,
Philadelphia (Cappella); Texas A&M University,
College Station (Street); Baylor College of Medicine,
Houston, Texas (Street).
Corresponding Author: Joseph N. Cappella, PhD,
Annenberg School for Communication, University
of Pennsylvania, 3620 Walnut St, Philadelphia, PA
19104-6220 (Joseph.Cappella@asc.upenn.edu).
Published Online: February 1, 2024.
doi:10.1001/jama.2024.0371
Conflict of Interest Disclosures: None reported.
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