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RESEARCH PRODUCT

Communication skills in medicine: where do we come from and where are we going?

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The physician-patient relationship has changed throughout history, as the role of physician has been transformed. Modern physicians need to be educated on how to use highly specialized knowledge when approaching the patient as a unique and whole person living in a given psychological, social, and material context. This relationship evolved from a paternalistic model to a cooperative-deliberative one, representing a meeting between two “experts:” the physician as the medical expert and the patient as the expert on himself. According to this model, communication between patients and physicians must be based on common understanding in a caring and dynamic relationship that also involves the patient’s family. Nevertheless, this new approach is not free from difficulties, because physicians have to learn to adapt to its demands. This situation has led to a new concept known as the “empowered patient” (1). Effective physician-patient communication is a central clinical function in building a therapeutic relationship. Therefore, in recent decades great attention has been paid to the quality of communication in medicine. However, the educational background and characteristics of communication skills teaching are a less studied field. Anglo-Saxon countries are pioneers in integrating this subject into undergraduate and postgraduate medical education. Less is known about other countries, especially Spanish-speaking and Central and Eastern European countries (2-4). The only way the future physicians (today’s students) can develop effective communication with their patients is to integrate this teaching at the university level. Therefore, it was necessary to analyze how teaching of communication skills in medical schools has evolved. This essay provides a brief historical analysis of the integration of this teaching in the pioneering countries. We also focus our attention to Spain and Croatia, where our teams come from. It can be said that these reflections are the result of teamwork and collaboration between Croatia and Spain.