What makes a physician an exemplary communicator with patients? Toni Suzuki Laidlaw a, * , David M. Kaufman b , Joan Sargeant a , Heather MacLeod a , Kim Blake c , David Simpson d a Division of Medical Education, Dalhousie University, Canada b Learning & Instructional Development, Simon Fraser University, Canada c Department of Paediatrics, Dalhousie University, Canada d Department of Medicine, Dalhousie University, Canada Received 27 November 2006; received in revised form 4 May 2007; accepted 29 May 2007 Abstract Objective: A pilot study was conducted to examine the characteristics, capacities (beliefs, values and intentions) and skills that distinguish exemplary communicators from less exemplary communicators in patient–physician encounters. Methods: Forty physicians participated in a four-station videotaped OSCE focusing on a variety of adolescent sexual health issues and assessed using seven quantitative measures. Results determined the top 15%, and the bottom 15%. An interviewer reviewed and discussed two of the videotaped scenarios with physicians in both groups. Interviews were analyzed to determine differences between groups. Results: Results consistently identified the top 15% (6) and bottom 15% (6) physicians. The t-tests showed statistically significant differences on all skills and capacity measures. ‘‘Notable’’differences (25% or higher) were found on two quantitative instruments assessing skills. There were no notable differences in capacities. The qualitative inquiry confirmed notable differences in skills and identified capacities of empathy, non- judgement and self-reflection as restricted to the exemplary group. Conclusion: Using quantitative and qualitative measures, it is possible to determine skills and capacities that distinguish exemplary commu- nicators from less exemplary communicators. Practice implications: In addition to effective skills, physician empathy, non-judgement and self-reflection appear to be necessary components for exemplary physician communication with adolescents. # 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Communication skills; Empathy; Non-judgement and self-reflection; Exemplary physician communicators; Adolescent patients 1. Introduction Patient–physician communication is now acknowledged to be a core clinical skill. Yet few studies have examined exemplary physician communicators in depth. A pilot study was designed to answer the following two questions. (1) Can exemplars in patient–physician communication be objectively identified? (2) What are the characteristics, performance skills and capacities that distinguish them from less exemplary communicators? Based on the participation of 40 primary care physicians, the top 15% and bottom 15% (n = 12) were identified and each group was examined using quantitative and qualitative means of analysis. Also, the relationships of characteristics, capacities and demographics with performance were examined for the whole group. In our study, capacities refer to physicians’ values, beliefs and intentions concerning the patient and encompass the affective and moral dimensions of medical practice, including compassion, empathy, trustworthiness, respect, honesty and integrity [1,2]. They also comprise the physician’s ‘‘habits of mind’’, i.e., the capability to be self-aware and reflective about these interactions [2]. While capacities are recognized as essential to overall physician professionalism and competence, effective inter- viewing skills are also essential to enhance patient care. These skills comprise a patient-centred, relationally competent approach to the medical interview that ensure medical www.elsevier.com/locate/pateducou Patient Education and Counseling 68 (2007) 153–160 * Corresponding author at: Division of Medical Education, Dalhousie University, Clinical Research Centre, Rm C-115, 5849 University Avenue, Halifax, Nova Scotia B3H 4H7, Canada. Tel.: +1 902 420 8604; fax: +1 902 494 2278. E-mail address: tonilaidlaw@eastlink.ca (T.S. Laidlaw). 0738-3991/$ – see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2007.05.017