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Years spent seeking a diagnosis of Hailey-Hailey disease taught Paulo Victor Zattar Ribeiro, MD, that feeling heard can be as important to patients as finding answers.

Speaking with Medscape’s Portuguese edition, Ribeiro, medical geneticist and fellow in oncogenetics at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo in Ribeirão Preto, Brazil, noted that his experience revealed two important lessons: Patients often feel unheard during their illness, and in some cases, the diagnosis itself can bring a sense of healing.

“I didn’t feel heard,” said Ribeiro. “Only one doctor actually asked how I felt and what impact the disease was having on my quality of life. All the other doctors just wanted to investigate my disease from a technical standpoint.”

His experience is not unique. A qualitative study published in Clinics examined the factors that shaped patients’ trust in their physicians and their satisfaction with the care they received. The study involved 60 patients attending a preoperative assessment clinic at Hospital das Clínicas, a tertiary teaching hospital, University of São Paulo in São Paulo, Brazil.

“My clinical experience showed me that an association exists between communication and clinical outcomes, but it also made me curious about how that relationship develops,” said Carlos Frederico Confort Campos, MD, PhD, general practitioner, registrar, and honorary lecturer from the Center for Development of Medical Education, Universidade de São Paulo, and the Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand, in an interview with Medscape’s Portuguese edition.

The study found that patients often do not separate technical competence from relational competence. In one testimonial, a patient said they trusted their physician because he “looked me in the eye” and spoke “as an equal.” Another patient reported satisfaction because the physician “listened” before assuming that she already understood the case.

“Communication rarely has a direct effect on an isolated biologic marker, such as blood pressure or cholesterol, but it can influence important intermediate outcomes in patient care,” Campos said. “Communication is central to establishing a therapeutic relationship. And that therapeutic relationship can, in fact, affect clinical outcomes.”

The researchers identified three major groups of factors that shape satisfaction and trust: medical competence, patient subjectivity, and the institutional context of care. In practice, patients evaluate a consultation not only by whether their health problem is resolved but also by seemingly simple signals such as eye contact, willingness to listen, clear explanations, kindness, and genuine interest during the conversation.

Ribeiro’s experience illustrates these findings.

“Communication in healthcare involves listening much more than speaking,” he said.

In medical genetics, consultations often involve uncertainty, a lack of effective treatment, and conversations that can be devastating for patients and their families. In these situations, he believes that communication can profoundly shape the emotional experience of illness.

“I’m always honest about the diagnosis,” he said. “But I also need to offer hope, a sense of perspective, and positive aspects.”

According to Ribeiro, one of the greatest mistakes in medicine is equating a cure solely to the absence of disease.

“Often, for a family, the cure is finally understanding what is happening.”

The geneticist recalled the case of a child who arrived at the clinic with severe impairments in vision, hearing, speech, and neuropsychomotor development after years without a diagnosis. When the genetic syndrome was identified, the child’s mother began to cry.

“She said, ‘I’m crying out of relief because I finally know what my son has,’” Ribeiro recalled. “She blamed herself for the child’s condition and believed she would never find another family going through the same thing. The diagnosis was her cure.”

Technology Impact

“The growing use of technology, diagnostic tests, and medical equipment often leads physicians to focus exclusively on test results while neglecting the patient’s medical history and physical examination, which remain essential to diagnosis,” warned Antonio José Gonçalves, MD, PhD, professor and chair of the Head and Neck Surgery Division in the Department of Surgery from the Faculty of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil.

A systematic review of studies published between 2010 and 2024, co-authored by Aline Rodrigues Gomes, PhD, from the University Centre of Volta Redonda in Volta Redonda, Brazil, found that automated consultations, excessive use of technical jargon, and constant interruptions while patients describe their symptoms are among the main factors that undermine the quality of care.

“Many patients leave the physician’s office without fully understanding their diagnosis, the prescribed treatment, or the risks associated with their condition,” said Gomes, communications specialist and doctoral candidate in business administration.

“The most common communication failures are the lack of eye contact and the absence of clear explanations about symptoms and treatments,” Gonçalves said.

According to Gonçalves, test results must be interpreted “in light of how the patient feels.”

Practical Listening

“The simple act of being heard already has a therapeutic effect,” said Fabrícia Signorelli, MD, psychiatrist with a master’s degree in developmental disorders at the Federal University of São Paulo, São Paulo, Brazil.

According to Signorelli, many patients discontinue treatment or repeatedly change physicians when they feel that their concerns have been dismissed during consultation.

In the University of São Paulo study, the authors argued that trust and satisfaction function as intermediate outcomes between communication and health, influencing patient behavior, adherence, and continuity of treatment.

“Ensuring that patients have an opportunity to speak without interruption at the beginning of the appointment is essential,” Gomes said. “Asking whether they understood the information or have any questions provides important feedback about how well the message was received.”

“Speaking in a way that patients can understand is essential,” Gonçalves said.

“Phrases such as ‘I understand that this may be difficult’ can make a difference,” Gomes noted. “Shared decision-making is also important, taking into account the patient’s reality, culture, and available options.”

Campos noted that interpersonal skills continue to receive less emphasis in medical education.

“Much of the learning of these skills comes through observation. Students often train in environments that are highly mechanized or dehumanized,” he said.

According to Gonçalves, medicine must be reconnected with its humanistic values.

Quoting William Osler, MD, he summarized it as: “A good doctor treats the disease; a great doctor treats the patient who has the disease.”

Daniela Barros is a journalist from Brazil, specializing in social journalism at the Pontifical Catholic University of São Paulo in São Paulo, Brazil, and a master’s student in the Department of Social Medicine at the Ribeirão Preto Medical School in Ribeirão Preto, Brazil. She has been involved in medicine for 23 years and has contributed to several specialized publications.

Roseane Santos is a Brazilian journalist with 35 years of experience who has worked for major national outlets like Universo Online, the daily newspaper Folha de S.Paulo, and Portal Terra and contributes to scientific publications from Albert Einstein Israelite Hospital and Brazil’s National Cancer Institute.

This story was translated from Medscape’s Portuguese edition.