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Assessing patient-centred care through direct observation of clinical encounters
  1. Jennifer N Stojan1,
  2. Michael A Clay2,
  3. Monica L Lypson3,4
  1. 1Departments of Internal Medicine and Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
  2. 2Ann Arbor Veterans Affairs Healthcare System, and Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
  3. 3Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan, USA
  4. 4Departments of Internal Medicine and Learning Health Sciences, and Office of Graduate Medical Education, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Monica L Lypson, Ann Arbor VA Healthcare System, Professor of Internal Medicine & Learning Health Sciences, University of Michigan Medical School, 2215 Fuller Road #11J, Ann Arbor, MI 48105, USA; mlypson{at}

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Patient-centred care, defined as respecting and responding to the needs and preferences of patients, empowering them to make decisions that best fit their individual needs, has been identified by the Institute of Medicine as an essential element of high-quality care.1 It can be thought of as respectfully involving the patient2 in a way that helps practitioners provide care that is concordant with their patients’ values, needs and preferences while better enabling patients to actively provide input and participate in their healthcare.3 Patients are more satisfied with their care when they feel that healthcare providers are understanding their needs, carefully listening and clearly providing information4; in addition, patient-centred care has been found to be associated with improved patient outcomes.5 In order to provide exemplary patient-centred care, one needs well developed communication skills, especially in the realm of active listening and responding to patient cues. The importance of physicians mastering the art of patient-centred communication skills can be seen as a theme in the educational objectives of medical school curricula as well as in the competencies of the Accreditation Council for Graduate Medical Education.2

Approaches to evaluating patient-centred communication skills include patient surveys that assess satisfaction with a healthcare provider6 and direct observation. Training programmes employ standardised patients to directly observe communication skills such as with Objective Structured Clinical Examinations.7 Direct observation can also occur in real time or through videotaped or audiotaped real patient encounters. When using audiotaped encounters, the ‘Content Coding for Contextualization of Care’ or 4C method can be used to evaluate clinical care performance.8 With this method, audio recordings of patient–provider encounters are used to assess whether care planning has taken …

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