Clinical Communication Skills

Effective clinical communication is foundational to patient-centred care and safe practice. The Calgary-Cambridge framework provides a structured approach to the clinical encounter, encompassing initiating the session, gathering information, building the relationship, explanation and planning, and closing the session. Each domain requires distinct micro-skills that can be practised and refined throughout your training.

The ICE model — Ideas, Concerns, and Expectations — is a core tool for patient-centred interviewing. Eliciting a patient's ideas means asking what they think is causing their problem; their concerns relate to what they are most worried about; and their expectations address what they hope to gain from the consultation. Failing to explore ICE leads to misunderstanding, non-adherence, and patient dissatisfaction.

Motivational interviewing (MI) uses the OARS framework: Open questions invite elaboration rather than yes/no responses; Affirming acknowledges the patient's strengths; Reflecting back demonstrates understanding and encourages deeper exploration; Summarising consolidates key themes. MI is especially useful when discussing behaviour change such as smoking cessation, alcohol reduction, or medication adherence.

Breaking bad news requires particular care. The SPIKES protocol offers a reproducible sequence: Setting (private, quiet space, consider who should be present); Perception (assess what the patient already knows); Invitation (ask how much information the patient wants); Knowledge (deliver news clearly, avoid jargon, use pauses); Emotions (acknowledge and respond to emotional reactions with empathy); Strategy and Summary (outline next steps and check understanding). Allow silence after delivering difficult information — resist the urge to fill the gap immediately.

Communication across cultural and language barriers demands awareness of health literacy, culturally shaped illness models, and the critical role of professional interpreters. New Zealand guidelines strongly advise against using family members as interpreters for clinical matters: family members may filter, omit, or distort information, and their presence compromises patient confidentiality. Professional telephone and in-person interpreter services are available in most NZ DHB settings and must be used whenever a patient's English proficiency limits clinical communication. When working through an interpreter, speak directly to the patient rather than to the interpreter, keep sentences short, and check understanding frequently using the teach-back method.