• Lynne Robins, Saskia Witteborn, Lanae Miner, Larry Mauksch, Kelly Edwards, and Douglas Brock.
• Department of Medical Education and Biomedical Informatics, H205 Health Sciences Center, Box 357240, Seattle, WA 98195-7240,USA. lynner@u.washington.edu
• Patient Educ Couns. 2011 Apr 1; 83 (1): 73-9.

ObjectiveTo categorize physician communication demonstrating understanding of what patients want to know and skill in conveying that information. Physicians underestimate how much information patients want and patients rarely seek information during clinic visits. Transparent communication is advocated to facilitate patient understanding and support autonomy, informed decision-making and relationship development.MethodsAnalysis and coding of 263 audiotaped interactions between 33 primary care physicians and their patients in eight community-based, primary care clinics in Washington State, USA.ResultsPhysicians proactively used five types of process transparency to preview speech and actions. Four types of content transparency were used to explicate diagnosis and treatment, demystify medical language and concepts, and interpret biomedical information. Physicians spent the greatest proportion of clinic time explicating medical content.ConclusionThe primacy of information exchange over process-oriented, relational communication was demonstrated. Proactive transparency appears promising to increase understanding and collaboration.Practice ImplicationsIn patient-centered care where collaboration is the ideal, transparency in its various forms is a critical ingredient. Without much communicative effort, physicians who proactively communicated that an examination was over, that they were leaving the exam room briefly so patients could dress provided information that appeared to address patient uncertainty and demonstrated empathy and respect.Published by Elsevier Ireland Ltd.

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