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Like politics, clinical negotiation is the art of the possible. However, in contrast to politics (where some would say the driving force is money), the essence of clinical negotiation is good communication. When patients and clinicians are struggling to find common ground, effective communication is how clinicians help patients understand their health states and treatment options, uncover what patients think and what’s important to them, foster caring and compassionate relationships, work out differences of opinion, and collaborate to reach decisions based on the evidence and consistent with patient values. In this framework, communication is integral to safe, effective, efficient, patient-centered, timely, and equitable health care.1–3 Our goal in writing this book was to provide in-depth analysis and guidance for clinicians striving to accomplish these goals as they seek to find common ground with patients.

And yet, some may still question whether communication skills are too soft, too ethereal, or too remote from real medicine to count for much. This view is encapsulated in the challenge offered by some of our colleagues over the years: would you rather have a surgeon with a great bedside manner and a 3% surgical mortality rate or one with the personality of cardboard and a 1% mortality rate?

We reject that Hobson’s choice. We want good technical quality of care and good communication. In fact we would argue that they are related to one another. In this concluding section, we offer a glimpse of the evidence demonstrating how and why communication matters, especially as it concerns the clinical negotiation.


Patient satisfaction with health care, adherence to treatment regimens, and shared understanding are important indicators of health care quality. Patients typically report greater satisfaction with their care when physicians are perceived as good listeners, are interested in what patients have to say, provide understandable explanations of complex medical information, address patient’s questions and concerns, treat patients with respect, and include patients as active participants in health care decision-making.4 Shared decision-making, an important component of effective clinical negotiation, often leads to greater patient understanding and less decision regret.5

Other research has investigated the relationship between clinician-patient communication, adherence to medical recommendations, and health outcomes. A 2009 systematic review6 of research on the relationship between adherence and three aspects of physician communication found a 19% higher risk of poor adherence among patients seeing physicians who provided scant information, neglected psychosocial concerns, and failed to build trust and rapport. Moreover, the odds of patient adherence were significantly higher when physicians received training in communication skills. In related research, adherence tended to be higher when patients (especially those belonging to racial and ethnic minority groups)7,8 believed they and the clinician were “working together.”9,10

A major theme of this book is the centrality ...

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