Physician assistants (or associates1) (PAs) are inte­gral team members who are essential to clinical delivery in many settings. Interprofessional team-based care has evolved and had a positive impact on practice perfor­mance as well as health outcomes, while encouraging the development of trust within the provider-patient relation­ship.2 Evidence shows that including PAs on interdis­ciplinary teams increases access to care, reduces health care costs, and improves outcomes,3 none of which would be possible without a strong foundation of trust between provider and patient.

The American Academy of Physician Assistants and the Physician Assistant Education Association published a joint statement on required competencies for the PA profession. Within a PA training program, training on interpersonal and communication skills is required and professional competencies include, “the effective and appropriate application of medical knowledge, interper­sonal and communication skills, patient care, profes­sionalism, practice-based learning and improvement, and systems-based practice”.4

The nonprofit Primary Care Collaborative (PCC) pro­motes a transformation of the health care delivery system that is built on a strong foundation of primary care using a medical home model. The PCC model promotes an inter­disciplinary team approach that includes PAs focused on patient engagement and trust. This model is patient-cen­tered, coordinated, accessible, and committed to quality and safety.5 In order for patients and families to man­age and organize their care and fully participate in shared decision-making, there must be a focus on strong and trusted relationships with the care team and open com­munication regarding health status.

Communication is central to building trust and sup­porting patient satisfaction. PAs are especially skilled at patient-centered communication; PA practice reflects a deep commitment to interpersonal communication skills that address verbal, nonverbal, written, and elec­tronic communication.4 This dedication and empha­sis on communication skills results in increased patient activation and has led to the development of evidence-based Patient Activation Measures.6 The concept of patient activation offers clinicians a unique opportunity to assess and understand an individual patient’s ability to engage with their health care team, develop a greater understanding of chronic health conditions, and there­fore have informed decision-making for future treat­ment. Patients seeking health care services must not only to engage with a team of health professionals but also have the capacity and willingness to follow instructions immediately after treatment or a stay in hospital, and/or to come in for preventive wellness care.6 Some health care providers may have an overly optimistic view of their patients’ ability to actively participate in their care; some have developed a number of ways of tailoring care deliv­ery according to a patient’s level of activation. Examples of enhanced resourcing and communication tailored to patient activation may include allocating or tailor­ing resources to particular patient groups, adjusting the speed of access to and/or frequency of contact with the health care team, and maximizing the value of primary care and specialty appointments for less-activated, less-engaged patients.6

Interprofessional communication tailored to patient need and readiness is a core competency for developing trust, which is critical. Effective exchange of health infor­mation has been shown to encourage and promote patient engagement in decision-making and promote clinician response to patients’ emotions when discussing treatment.7 PAs are trained as skilled communicators, adept at connection and building patient relationships. PAs are also knowledgeable about how best to address patient hesi­tancy and concerns that can lead to doubt and challenges in accessing needed clinical services for chronic disease management. Patient-centered discussion and facilitation of information exchange, often used by PAs, can generate trust and assist with developing a strong clinician-patient relationship.6 Empathetic communication also seems to support more accurate information-gathering by clini­cians, eliciting clarity of information provision and there­fore enhancement of patient trust.7

Advocacy must continue to support team-based care and adequate training to ensure that new clinicians are communicating effectively with patients and building positive trust. The Joint Commission has made significant efforts to better understand individual patients’ needs and to provide guidance for health care organizations working to address those needs.8 Initially, the Joint Commission focused on studying language, culture, and health literacy issues, but later expanded its scope of work and training materials to include the broader issues of effective com­munication, cultural competence, and patient- and family-centered care.8 No longer considered to be simply a patient’s right, effective clinician-patient communication is now accepted as an essential component of quality care and patient safety.8

Patients are far more likely to trust PAs and health care professionals who are open and honest in their approach, admit to errors, apologize when necessary, and do every­thing in their power to rectify any mistake.9 PAs, like many other licensed professionals on the interdisciplin­ary care team, must meet standards of safe practice and continuous education throughout their careers. Continued professional development and ongoing refinement of skills needed for effective communication remain priorities for high-performing PAs and all members of interdisciplinary care delivery teams.

Disclosure of interests

The author’s title at UnitedHealthcare is Chief Population Health Officer, Managed Medicaid Plan of NC. All opinions stated within this work are the author’s own and this work is an independent work prod­uct, done outside of her regular job responsibilities.