Communication: A competence without which all others may be meaningless

In recent years, the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties have emphasized the importance of education in, and achievement of, six core competencies. Both organizations-one accrediting medical residency and fellowship programs, the other functioning as the umbrella organization for the certification boards of all 24 medical and surgical specialties-have stressed that every physician should achieve and maintain competence in patient care, medical knowledge, communication skills, professionalism, practice-based learning and improvement, and systems-based practice (which is the awareness of how important the entire system of health care is to the health of patients).

I have no argument with the fact that all six core competencies are essential. But as we consider competence in the context of patient care-inpatient or outpatient, for trainees or for practicing physicians-I've become convinced that the most important of the six competencies is skill in communication. Consider these situations:

In each transaction, and in many more that occur daily, the medical outcome depends on the accuracy, completeness, tone of voice, diplomacy, clarity, sense of urgency, and legibility of the communicator. We've begun to understand that negotiation with parents and patients is a skill that must be purposefully developed and that the health of a child while he, or she, is out of our care may depend on our success in achieving that skill.