From the first day of medical school, most physicians are indoctrinated with the concept that open communication with our patients is how medicine should be practiced. Regardless of our specialty, this forthright approach is thought to be the ideal. Whether it is taking a solid history, revealing a diagnosis, discussing therapeutic options and adverse events, discussing disease prognosis, or even conveying distressing information, this approach is the gold standard of management. We are communicating not only with the patient, but also with significant others such as family, partners, and friends; therefore, the physician must often repeat the message to different listeners. In the environment of medicine today in Canada and in many other places, is this situation ideal, and if so what is the cost?
In the setting of shortages, whether it is manpower, access to consultation or testing, therapeutic maneuvers, or blunt cost, what are the issues to consider when properly communicating with the patient? In this focus article, I do not offer new insights, just a perspective.