Communication Study Identifying transparency in physician communication Lynne Robins a, *, Saskia Witteborn b , Lanae Miner c , Larry Mauksch d , Kelly Edwards e , Douglas Brock a a Department of Medical Education and Biomedical Informatics, Seattle, WA, USA b School of Journalism and Communication, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong c University of Washington School of Medicine, Seattle, WA, USA d Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA e Department of Medical History and Ethics, Seattle, WA, USA 1. Introduction Studies of physician–patient communication have demonstrat- ed over time the primacy of information exchange in clinical encounters [1–3]. When asked to identify competent communica- tion behaviors during a medical consultation, both physicians and patients emphasize information exchange over relational com- munication [4], though disentangling relational and informational talk can be difficult and even beside the point. Roter has shown that patient adherence improves when physicians convey technical information in ways that imply caring and concern [5,6]. Information gathered from patients during medical history-taking is vital to physicians for making medical diagnoses and treatment decisions; in the majority of cases, it is considered more valuable than information derived from lab results or physical examination [7,8]. For patients, the clinical encounter offers a venue in which they can learn about their health conditions and self-care through receipt of medical and treatment information from their physicians [9]. Patients express a strong desire for medical information [10,11] yet, physicians often underestimate how much information patients want about their physical exams, medications, tests, and therapies [12]. And, despite their interest in receiving information, patients exhibit relatively low rates of information- seeking behaviors during clinic visits [11,13,14]. Previous studies have reported that patients are reluctant to ask questions about medications during medical visits [15,16] due to fear of physicians’ reactions to their questions [17]. Noted communica- tions researchers including Waitzkin [18], Roter [19], West [20], and Frankel [21] have suggested that there is a ‘‘dispreference’’ for patient-initiated questions in the medical interview. Ideally, physician–patient communication would exhibit a more ‘‘balanced exchange of information, ideas, and preferences between the physician and patient, with each playing a complementary role during the interaction’’ [22]. Instead, medical communication takes on an asymmetrical shape, deformed by a process of ‘‘collusion’’ that produces only an ‘‘appearance of shared understanding’’ [23]. Patient Education and Counseling 83 (2011) 73–79 ARTICLE INFO Article history: Received 29 April 2009 Received in revised form 29 April 2010 Accepted 8 May 2010 Keywords: Physician–patient communication Transparent communication Patient-centered care ABSTRACT Objective: To categorize physician communication demonstrating understanding of what patients want to know and skill in conveying that information. Physicians underestimate how much information patients want and patients rarely seek information during clinic visits. Transparent communication is advocated to facilitate patient understanding and support autonomy, informed decision-making and relationship development. Methods: Analysis and coding of 263 audiotaped interactions between 33 primary care physicians and their patients in eight community-based, primary care clinics in Washington State, USA. Results: Physicians proactively used five types of process transparency to preview speech and actions. Four types of content transparency were used to explicate diagnosis and treatment, demystify medical language and concepts, and interpret biomedical information. Physicians spent the greatest proportion of clinic time explicating medical content. Conclusion: The primacy of information exchange over process-oriented, relational communication was demonstrated. Proactive transparency appears promising to increase understanding and collaboration. Practice implications: In patient-centered care where collaboration is the ideal, transparency in its various forms is a critical ingredient. Without much communicative effort, physicians who proactively communicated that an examination was over, that they were leaving the exam room briefly so patients could dress provided information that appeared to address patient uncertainty and demonstrated empathy and respect. Published by Elsevier Ireland Ltd. * Corresponding author at: Department of Medical Education and Biomedical Informatics, H205 Health Sciences Center, Box 357240, Seattle, WA 98195-7240, USA. Tel.: +1 206 616 9874. E-mail address: lynner@u.washington.edu (L. Robins). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter . Published by Elsevier Ireland Ltd. doi:10.1016/j.pec.2010.05.004