Communication: the royal pathway to patient-centered medicine.

The papers in this special issue on communication in health care can be summarized in one easy and powerful message: communication is the royal pathway to patient-centered medicine. Approached from different angles, the linkage between communication and patient-centered medicine is the common theme that is covered by all authors. Underlying are two distinct assumptions: the first is, that patient-centered medicine is a relevant aim in health care; the second, that communication is an important tool to achieve that aim. Both assumptions deserve some exploration. We are at the verge of a new paradigm-shift in health care. Norms and values that were long taken for granted seem to be changing. The authoritative doctor who is supposed to make all medical decisions takes gradually place for a model of shared decision making by physicians and patients together. There also is now a widespread belief that not diseases but patients must be the focus of health care. The most pronounced this paradigm-shift is verbalized by Roter (pp. 5–15) who reactivates in her theoretical contribution George Engels earlier predictions about a major paradigmshift at the turn of the century: ‘‘just as the molecular and chemistry oriented sciences were adopted as the 20th century medical paradigm, incorporation of the patient’s perspective into medicine’s definition of patient need has been suggested as the medical paradigm of the 21st century’’. Roter introduces the medical dialogue as ‘the fundamental vehicle through which the battle of perspectives is waged and the therapeutical relationship is defined’. The paradigmatic character of patient-centered medicine is also described by Bensing (pp. 17–25) who contrasts it with that other appealing new paradigm, that seems to take health care by storm: evidence-based medicine. While Roter describes the paradigm-battle as a battle between an ‘old’ and a ‘new’ paradigm, Bensing’s analysis shows the more dangerous perspective of two concurring paradigms that – although both growing in popularity – yet seem to belong to different, perhaps even conflicting worlds. In her view communication between physician and patient should and could bridge the gap between these promising new paradigms in health care. As sympathetic as it is, one could yet wonder what the background is of this widespread enthusiasm for patient-centered medicine. Its implication is a power-shift from physician towards patient, and refraining from power is seldom a voluntary act by the powerful party. Yet it seems to happen, and not only because of the pressure of emancipating patients, but also because many physicians themselves are advocates of this movement. Many physicians sincerely feel that patient-centeredness is a requisite for good quality of care. Arguments are given throughout this Special Issue by various authors. Let us summarize them under three headings.