Chapter 1 emphasised how respect for patient autonomy has become more central to the doctor–patient relationship while beneficence has been diminished in importance because of its paternalistic overtones. Effective communication strengthens patient autonomy by enhancing understanding and is essential for good medical practice. It is the means of history taking, obtaining consent for examinations and procedures, and explaining diagnoses and treatment. Effective communicators are able to establish rapport, trust and confidence with patients more easily than ineffective communicators, thereby enhancing the flow of crucial information and increasing the likelihood that advice will be heeded. Effective communication decreases the likelihood of complaints, acrimony or legal action if adverse events occur [2–3]. Good communication skills alone are not sufficient for professional medical practice and must be accompanied by clinical competence, empathy and ethical behaviour. Good communication skills are also a necessary prerequisite if the doctor is to provide effective leadership of the ‘health-care team’.

Effective communication also improves the quality of health care [5–6] and can have a very positive effect on the satisfaction gained from a consultation by both doctor and patient. Breakdowns in communication are the most common basis of patient dissatisfaction. Surveys show that dissatisfied patients criticise their doctor for not listening, for not providing adequate explanations or for appearing disinterested. Satisfied patients perceive their doctor to demonstrate humaneness, understanding, ability to listen without hurrying the patient, and the skill of involving the patient in decision making [7–9].