We interviewed a total of 17 participants, comprising 11 physicians and 6 patient relations coordinators (
Thematic analysis of the interview data identified 2 overarching themes: barriers and facilitators of effective physician-patient communication. As shown in
Overview of the themes. AI: artificial intelligence.
Physicians reported that patients’ educational levels directly influenced communication effectiveness, with particularly notable differences between highly educated and less educated patients. Many highly educated patients tended to arrive with strong preformed views about their conditions, sometimes displaying overconfidence and questioning physicians’ clinical judgments. Conversely, patients with limited education required extensive, repeated explanations to understand medical information, frequently resulting in miscommunication. For these patient groups, the standardized communication methods taught in medical schools were largely ineffective, and time constraints in high-volume outpatient settings made it difficult to tailor communication strategies to individual patients. As one physician explained,
For some well-educated patients, the problem lies in overconfidence; for others, I need to explain and rephrase multiple times before they can understand what I mean.
Patient age also shaped communication dynamics. Younger patients demonstrated higher autonomous learning motivation and were more likely to form preliminary self-diagnoses before consultations, a tendency exacerbated by the digital information environment elaborated in the subsequent section (see “System-Level Barriers”). Furthermore, they often approached health care from a consumerist perspective, expecting guaranteed outcomes and engaging in what participants described as excessive rights protection behaviors, such as recording consultations and filing complaints. Such behaviors often prompted physicians to adopt defensive communication practices, including avoiding discussions of clinical uncertainty. As a member of the physician-patient relations office noted,
Many young patients treat medical consultations like ‘online shopping,’ expecting guaranteed treatment outcomes and a ‘seven-day free return’ policy. However, medicine is inherently fraught with uncertainty, and no one can guarantee outcomes...Some patients record every interaction, forcing physicians to speak with excessive caution and hesitate to discuss treatment uncertainties.
Inadequate symptom expression and limited health literacy are the primary patient-level barriers to physician-patient communication. Physicians reported that many patients lacked the ability to accurately describe symptoms and express their core consultation needs clearly. Patients often used colloquial language, requiring physicians to adjust their questioning strategies repeatedly and clarify complaints through follow-up inquiries. Even so, patients frequently provided irrelevant responses, resulting in the loss of key clinical information. One physician elaborated on the difficulty of obtaining effective clinical information:
When I ask under what specific circumstances the stomach pain occurs, they just repeat ‘severe bloating’ without answering the actual question...Sometimes we spend five minutes and still cannot obtain the necessary information, which leaves us feeling quite helpless.
One physician further noted,
Patients who can clearly express their conditions and are quite professional are actually rare... The health literacy of most patients in China still has significant room for improvement.
Beyond incomplete symptom descriptions, participants emphasized a significant disconnect between patients’ surface-level expressions and their underlying needs. One physician added,
Some patients are unable to clearly articulate their true needs; in fact, what a patient says during a consultation may not reflect their actual needs. If the doctor cannot discern this, communication will still fail even if the diagnosis is correct.
Physicians described encountering contradictory patient demands and misaligned expectations during treatment processes. On one hand, patients’ psycho-emotional status, such as disease-related anxiety, significantly disrupted communication. One physician provided a vivid example:
A patient might just have a sore throat, but it is accompanied by overwhelming anxiety, fearing they would be reprimanded by their boss, and might even lose their job.
Such intense emotional states caused patients to talk excessively and pose repetitive questions, overwhelming the physician and impeding effective clinical communication. On the other hand, expectation misalignment was also evident when patients sought definitive diagnoses or guaranteed outcomes while resisting the examinations or costs required to support clinical decision-making. As one physician stated,
Some patients hope for both definitive diagnosis and cost savings, which is somewhat contradictory in certain situations. For example, to give a definitive diagnosis, I need to order some examinations to find the root cause. Naturally, this requires more examinations, but once examinations increase, patients feel that costs might be higher, so contradictions exist here.
Physicians’ professional capabilities directly influenced their ability to understand and manage patient conditions. Good professional competence helped enhance patient trust and treatment compliance; conversely, insufficient professional capabilities not only weakened therapeutic effects but also reduced communication effectiveness. As one physician noted,
If I cannot clearly explain or show confidence in diagnosis, patients will naturally doubt what I say.
Some physicians exhibited authoritative tendencies in communication, often assuming patients could understand medical concepts while lacking the ability to translate professional information into accessible language. Communication involved excessive use of medical terminology and rigid language, tending toward unidirectional information delivery rather than shared decision-making with patients, sometimes displaying condescending attitudes. As a member of the physician-patient relations office observed,
Many physicians tend to dominate conversations. They use many professional terms, but patients often have no idea what they mean.
This approach not only weakened patient participation but also exacerbated power imbalances between physicians and patients, making patients feel ignored or disrespected. Furthermore, when facing physician-patient conflicts, some physicians lacked awareness of appropriate vulnerability demonstration and empathy expression, requiring improvement in communication skills. A physician remarked,
Physician-patient conflicts often escalate from verbal confrontations. In some cases, some conflict escalations occur when physicians insist on verbal dominance and want to win the argument. When patients feel disadvantaged in communication process, they may turn to other forms of confrontation, such as calling 12,315 (Chinese consumer rights complaint hotline), or engaging in physical confrontation. In my view, physicians do not need to compete for victory; instead, they can show appropriate vulnerability and defuse conflicts before they escalate beyond verbal confrontation.
Insufficient time was the most frequently mentioned communication barrier by physicians. Participants’ accounts showed that high patient volume, limited staffing, and heavy workload reduced the time physicians could allocate to each consultation. Several physicians described that, although they valued communication and recognized its importance in clinical care, time pressure often constrained them to provide detailed condition explanations. For instance, one physician stated,
Patients might wonder why physicians can’t give them more time. I also want to give them plenty of time, but I need to see 50 patients in one morning, with over ten people still waiting. My work pressure is also enormous; I can only try my best to do well.
Likewise, one physician noted,
it’s almost time to clock out, and there are still 10 to 20 people are queuing behind you...objectively, there is simply no time.
This perception was also echoed by a member of the physician-patient relations office, who commented,
Some physicians see 50 patients in a single morning. Do they realistically have the time to explain everything to each patient individually? Not possible.
Any problems in the medical care-seeking process, such as long waiting times or cumbersome examinations leading to poor visit experiences, could cause patients to project emotions onto physicians with whom they directly interacted. Emotional venting was one of the important causes of physician-patient communication conflicts. Some patients carried emotions from negative previsit experiences into communications with physicians. A member of the physician-patient relations office described,
The tipping point for a patient’s emotional outburst is rarely an isolated incident; rather, it is the culmination of their preceding experiences. For example, patients waited one or two hours to see the physician, the consultation is over in just two or three minutes. After that, patients have to go through examinations, wait for reports, make payments, and return visits. The whole process is very exhausting.
Although medical education invested heavily in clinical skill development, physician-patient communication training remained relatively underdeveloped, with curriculum content primarily focused on diagnosis and technical operations, while communication training for high-complexity clinical scenarios and patient emotional and psychological needs remained insufficient. This problem was particularly prominent among young physicians. Limited by clinical experience, they often lacked confidence in communication and struggled to quickly establish trust; simultaneously, patients questioned the professional authority of junior physicians, further exacerbating communication barriers. A member of the physician-patient relations office noted,
In school, physician-patient communication was not a core curriculum. Although hospitals provide training after employment, genuine communication skill improvement still depends on personal understanding. Because communication scenarios are complex, merely teaching communication theory cannot actually solve practical problems. Communication is a capability requiring lifelong learning.
Insufficient legal enforcement and protection mechanisms left both patients and physicians feeling vulnerable. Physicians reported that patients currently possessed numerous accessible channels for expressing demands; however, physicians lacked adequate advocacy channels when facing unreasonable demands, verbal abuse, or violence. This “legal vacuum” forced medical staff to adopt defensive postures, hindering honest dialogue about medical uncertainty or treatment limitations. Additionally, complex medical insurance policies (such as reimbursement scope and self-payment ratios) often became “noise” in physician-patient communication. Prescription authority restrictions, medical insurance reimbursement clauses, or hospital regulations often forced physicians to refuse patient requests. This “institutional rejection” was easily misunderstood by patients as physician indifference, exacerbating relationship tensions. As one physician stated,
If I cannot be certain of receiving protection when problems arise, I will avoid discussing any potentially controversial content.
One physician expressed similar difficulties,
Sometimes I must say ‘no’ due to regulations, but patients think I simply don’t care.
Participants described media narratives and digital health information environments as important barriers to effective physician-patient communication. For one thing, biased media coverage of negative medical incidents was found to foster patients’ preconceived distrust of physicians prior to consultations, which directly hindered the establishment of therapeutic rapport, mutual trust, and open communication. As one physician observed,
Some media’s negative medical reporting affects patients’ impressions of physicians. Patients believe physicians are making money from patients’ illnesses, arriving with such preconceived notions before visits. In such situations, it’s very difficult for physicians to change these prejudices through communication, so public opinion direction is extremely important.
On the other hand, the growing use of digital technologies and the wide availability of online health information introduced new communication challenges. Physicians reported that patients increasingly searched for health information online and, in some cases, used AI tools such as DeepSeek (Hangzhou DeepSeek Artificial Intelligence Co, Ltd) before or after consultations. Patients were often described as becoming partially informed through fragmented online or AI-generated information, without fully understanding the broader clinical context. This increased the explanatory burden on physicians and sometimes shifted consultations away from treatment planning toward the correction of misinformation. As one physician explained,
More and more patients come with DeepSeek recommendations. Although I’m willing to maintain an open attitude to communication, each time I need to spend time mutually sharing materials and judging which side is more reasonable and has stronger evidence, it’s quite exhausting. Sometimes I spend more time explaining why AI recommendations aren’t suitable for patients than discussing actual treatment plans.
Effective management of expectations was identified as a key characteristic of patients that facilitates constructive physician-patient communication. Participating physicians clearly preferred patients who understood the limitations of medicine, the complexities of diagnosis, and the uncertainties of treatment outcomes. As a member of the physician-patient relations office explained,
Many patients expect health to be a completely disease-free state. But medicine has its limitations. Physicians can only promise to improve conditions through treatment; a complete absence of disease is impossible. If patients can manage their expectations, we can have peaceful discussions about what is possible, rather than being forced to make promises that we cannot fulfill.
Physicians noted that such patients enabled more open and honest discussions about treatment options, potential outcomes, and associated risks.
Patients’ strong communication skills and adequate health literacy helped improve physician-patient interaction quality. Patients who could clearly present medical histories, ask targeted questions, and demonstrate understanding of basic medical concepts enabled physicians to focus more on complex decisions and personalized treatment.
If patients can clearly describe symptoms and understand basic terminology, we can spend more time developing treatment plans rather than starting from scratch.
Patients’ strong sense of health responsibility was also emphasized as a valuable factor promoting physician-patient communication. Physicians valued well-prepared patients who maintained organized medical records, obtained information from reliable sources, and asked clear questions.
A patient who communicates well knows they are the primary person responsible for their own health, rather than believing that medical visits are entirely the physician’s responsibility. Patients can prepare their past medical history materials as much as possible, allowing us to communicate and interact, examine disease development trends, making the entire diagnostic and treatment process smoother and more efficient.
Patient trust in physicians and shared decision-making more easily helped patients and physicians establish balanced and mutually trusting dialogue atmospheres. Physicians emphasized preferring patients who respected their professional knowledge while asking insightful questions, with shared decision-making during communication interactions being more aligned with patient needs.
Trust is the foundation. When patients trust physicians but still ask questions, this means they are actively participating in communication. This type of communication interaction more easily facilitates shared decision-making, helping patients choose treatment plans most suitable for their current personal situations.
Participating physicians emphasized that active listening and patient-centeredness were foundations of effective medical communication. Through attentive listening, asking follow-up questions based on patients’ verbal or nonverbal cues, and summarizing their core concerns, physicians not only made patients feel heard and valued but also reduced risks of missing important symptoms or worries. One physician mentioned,
I believe treating illness requires standing from the patient’s perspective, first treating the heart. Many patients don’t have physical illness but anxiety. When physicians patiently listen to their complete expressions, patients may feel half-better upon leaving the consultation room.
Empathy and emotional support were repeatedly mentioned as core elements for building trust and enhancing treatment compliance. Physicians who could recognize patient fears, acknowledge their concerns, and provide comfort could establish relationships transcending clinical interventions. Such connections were viewed as key to alleviating anxiety and enhancing patient confidence in treatment processes.
I believe a very important aspect of being a doctor is having understanding and empathy, being able to comprehend why patients say what they do; additionally, being able to make patients feel ‘this physician understands me’ from the first words spoken.
Using accessible language for clear explanations was viewed as key to bridging gaps between medical expertise and patient understanding. Physicians described the importance of translating professional terminology into colloquial language, using analogies or visual aids when appropriate, and confirming patient comprehension levels to improve communication. One physician emphasized,
Maintaining transparency when discussing diagnoses, treatment options, and prognoses was also viewed as a hallmark of effective communication. Physicians who frankly discussed uncertainties, limitations, and potential complications could maintain hope while setting realistic expectations, thereby avoiding disappointment and conflict. Many associated this transparency with more collaborative relationships, especially when combined with shared decision-making approaches that incorporated patient preferences and values.
I told them frankly what we knew, what we didn’t know, and what the risks were, and then we decided together how to proceed.
When interacting with diverse patient populations, cultural sensitivity and adaptive communication styles were viewed as crucial. Recognizing differences in health beliefs, communication preferences, and decision-making processes enabled physicians to adjust communication approaches accordingly, reducing misunderstandings and promoting respectful, culturally appropriate care. As one physician explained,
If you don’t understand the patient’s cultural background, you may be talking, but you’re not really connecting.
Physicians unanimously emphasized that institutional support and security assurance provided by medical institutions were important prerequisites for physicians to conduct effective communication. For example, hospitals’ zero-tolerance policies toward violence and abuse, along with clear behavioral standards and response mechanisms, made physicians feel more secure and confident when communicating with patients, thereby reducing defensive behaviors and promoting open dialogue. Transparent and efficient complaint handling processes were highly valued for protecting physicians from unfounded accusations while ensuring reasonable patient grievances were addressed. Multidepartmental collaboration and information-sharing mechanisms, along with third-party coordinator intervention (such as physician-patient relations offices, AI assistants, and patient companions), could effectively reduce information gaps and misunderstandings, ensuring continuity and smoothness in diagnostic and treatment processes. As a member of the physician-patient relations office said,
Patients always feel that they are the weaker party, but in fact they already have multiple channels for providing feedback. Healthcare workers are quite difficult because various parties may make all kinds of demands on them. Medical institutions should provide health care workers with more psychological, financial, and other forms of support, and ensure their safety, so that healthcare workers can focus on clinical work and form a virtuous cycle.
Physicians believed that streamlined processes could help shorten patient waiting times and reduce information delays. Additionally, providing patient health education to empower them to play an active role in their treatment was crucial for maintaining high-quality communication. In particular, patient education and health literacy improvement programs could help patients better understand medical information and actively participate in medical discussions, thereby reducing communication barriers caused by information asymmetry. As one physician explained,
If the appointment and check-in processes are straightforward and patients receive basic guidance beforehand, they will arrive less stressed and better prepared. We can use that time for what truly matters, such as collaboratively determining the best next steps.
Participants emphasized that education and policy interventions were key to maintaining and strengthening these facilitating factors. Embedding scenario-based communication training throughout medical education and professional development (such as role-playing, standardized patient simulations, and video reviews) could significantly enhance physicians’ practical communication abilities. Mentorship and exemplary demonstrations helped continuously reinforce communication skills in clinical environments, forming positive transmission. At the policy level, through patient rights and responsibility education, health care worker protection legislation, and performance assessments incorporating communication quality indicators, effective communication could become an important measure of medical services, incentivizing physicians to continuously improve communication abilities and ensuring sincere exchanges in safe environments. A member of the physician-patient relations office explained,
Physician-patient communication is not just one-time learning, but requires reminders, feedback, and support at every stage of professional careers.
In contrast to the communication barriers posed by fragmented internet information (as displayed in Theme 1), some physicians hold positive attitudes toward AI-assisted diagnosis when used by patients with adequate health literacy. They viewed it as a superior alternative to traditional, unreliable information sources. Highlighting this nuanced perspective, one physician stated,
I generally welcome these learning-oriented patients; at least most AI information is accurate. I’d rather they consult AI than turn to Baidu platform or listen to neighbors.
Simultaneously, some physicians emphasized that AI diagnosis required professional oversight to reduce risks and ensure patient benefits.
I maintain an overall positive attitude toward AI diagnosis. Relying solely on AI for diagnostic decisions carries risks, but these risks can be managed through professional oversight, ultimately benefiting patients at the patient level.
This divergence illustrates that the digital information environment acts as a double-edged sword, where its impact heavily depends on the patient’s underlying health literacy and the physician’s guiding approach.