On doctor-patient relationship and feedback interventions

The first consultation with a patient is the beginning of a doctor-patient relationship. It is thus of major importance to conduct this in a correct and proper way. Consulting with a patient is a complicated skill that is gradually learned during medical training and perfected when one grows into one’s role as a doctor. The importance of an adequate consultation constitutes a strong argument to start learning this skill early in medical training. Hegge et al. [1] describe the positive results of a longitudinal training project to teach this skill during clerkships. Almost three-quarters of the students were satisfied with the educational approach (practising with simulated patients) and felt well prepared to conduct their consultations with real patients. However, the authors rather easily brushed aside the disadvantages of the simulated patient situation felt by others, referring to studies that compared simulated patients with real patients and ‘mostly found no difference’. Using simulated patients indeed has advantages for instructiveness and for standardizing possibilities for testing performance. But what about the emotional impact, which is an intrinsic part of learning to become a doctor? Students may prefer ‘the real thing’. To distinguish the effects of communication between specialists and patients with medically unexplained physical symptoms (MUPS) on patient outcomes and use of health care, Weiland et al. [2] from four Dutch university medical centres performed a literature overview. Research in this field is limited and the articles included discuss different types of MUPS patients and describe different elements of communication strategies used by medical specialists. Nevertheless, their synthesis of data demonstrates that positive doctor-patient interaction and positive feedback from the doctor improves long-term coping with complaints as well as reducing use of health care. Schönrock et al. [3] suggest improvements of the (Cleveland) clinical teaching effectiveness instrument (CTEI) arguing that student perceptions of teaching quality