Effective patient-physician communication serves as the foundation of quality obstetric and gynecologic care, with specific skills needed to bridge power differentials and combat biases that disproportionately affect marginalized populations, according to a new Committee Statement from the American College of Obstetricians and Gynecologists.

The statement, published in December 2025, identifies three core recommendations for ObGyn physicians:

1. Master Relationship-Centered Communication Skills

Communication is the cornerstone of the patient-physician relationship. Effective practices can build positive relationships, enable sharing power, and lead to mutual trust.

The building blocks include acknowledgment of a patient's identity and experiences, clarity of information, patient activation and participation, knowledge-related power and authority, emotional proximity and shared experiences, and managing health care and relational goals. Relationship-centered communication skills include building rapport, negotiating an agenda, eliciting the patient's perspectives, demonstrating empathy, using plain language, and engaging in shared decision making.

Practical Tools for Physicians

The statement recommends training stills through simulation, role play, and observed coaching, to receive constructive feedback. Several frameworks exist to guide this work, including:

• Four Habits Model: A structured approach to patient-centered communication

• Presence 5: Fosters connection through five steps: prepare with intention, listen intently and completely, agree on what matters most, connect with the patient's story, and explore emotional cues

• NURSE mnemonic: For responding to emotion (Naming, Understanding, Respecting, Supporting, Exploring)

• EMPATHY framework: For demonstrating nonverbal cues (Eye contact, Muscles of facial expression, Posture, Affect, Tone of voice, Hearing the whole patient, Your response)

Universal Health Literacy Precautions

Beyond interpreter services, the guidelines point to using plain language and providing written information at a 6th-grade reading level as "universal precautions" to ensure all patients—regardless of educational background—can engage with their medical information and participate in decision making. This responsibility lies with all entities in the health care system.

Documentation Matters

Physicians should also use respectful language in medical records. The guidelines specifically recommend avoiding stigmatizing terms like "difficult patient," "noncompliant," "frequent-flyer," or "hysterical." Instead, clinicians should use factual descriptors of patient behavior (e.g., "discontinued medication" rather than "nonadherent") and person-first language (e.g., "person with a substance use disorder" rather than "addict"). Negative patient descriptors can predispose other professionals to have negative perceptions and potentially formulate less aggressive management plans.

2. Pause and Reflect to Interrupt Biases

Heuristics (or shortcuts) shape clinician daily practice and decision making; while often adaptive, protective, and efficient in many circumstances, they can pose the risk of creating cognitive errors that may bias care. Implicit or unconscious biases operate in all individuals, resulting from our natural tendencies to rely on pattern recognition.  The statement notes this becomes particularly detrimental because the patterns that are recognized and used to make judgments often are informed by stereotypes and "controlling images" that are "uniformly negative" and designed to dehumanize and discount marginalized populations.

Cultural Humility Over Cultural Competence

Cultural humility—defined as "an orientation to care that is based on self-reflexivity, appreciation of patients' lay expertise, openness to sharing power with patients, and to continue learning from one's patients"—represents a critical approach. This contrasts with cultural competence, which conveys a sense of knowing or mastery that feels finite and may lend itself to narrow, one-size-fits-all notions or assumptions about patients' preferences or values.

Recognizing and Repairing Trauma

The guidelines describe trauma-informed care as essential for recognizing how historical and collective trauma may surface in clinical encounters. Asking about prior experiences with trauma or whether patients have personal or family experiences of unfair treatment in health care settings can open valuable dialogue—though physicians should recognize that such disclosures may be activating or retraumatizing for some patients. Behaviors labeled as "difficult" or "noncompliant," may reflect coping strategies shaped by trauma. 

When biases operate or discrimination occurs despite best efforts, the guidelines highlight the importance of recognizing harms and attempting repair. This includes: (1) exploring the patient's experiences of bias or discrimination, (2) acknowledging the validity of the patient's lived experience and concerns, and (3) seeking to repair the breach to restore the relationship.

The Special Role of Empathic Communication

The statement notes empathic communication proves especially important when caring for marginalized patient populations. Greater affective communication behaviors, particularly related to emotion-handling and rapport-building, has been associated with improved trust, and may be especially important in racially or ethnically discordant patient–physician dyads.

Considerations for Neurodiverse and Differently Abled Patients

Communication needs vary across patients. While strong eye contact and handshakes are typically encouraged as best practices, these may be uncomfortable for neurodivergent patients. For Deaf and Hard of Hearing patients, physicians should ask about communication preferences, which may include American Sign Language, Certified Deaf Interpreters, or Communication Access Realtime Translation. Supporting patient understanding means knowing a person's learning preference (visual, auditory, tactile) rather than assuming. It's always best to ask.

3. Apply Best Practices with Interpreters

Physicians without adequate proficiency in languages other than English should always work with certified medical interpreters when communicating with patients with limited English proficiency.  Family members, friends, and unqualified bilingual staff, should only be used in rare emergencies or in situations where no medical interpreters are available. 

Best practices include identifying appropriate language, dialect, or regional variation before the encounter; selecting optimal interpreter modality based on clinical context; and huddling with interpreters to discuss context and goals. During encounters, clinicians should use inclusive language, ensure effective positioning with unobstructed views, speak directly to patients with good eye contact, use plain language while pausing after a few sentences, and employ teach-back methods to ensure understanding.

Even with interpreters, language discordance can hinder relationship-centered communication. Conversely, language concordance is associated with improved experiences and outcomes. The statement calls for sustainable practice models that increase visit duration when interpreters are needed to provide the same quality care as in English.

The Urgency of These Recommendations

The Committee Statement shows that although communication tools are essential, they do not address all barriers patients face. In addition to bias and stigma, patients from marginalized communities also face challenges accessing and participating equally in care decisions when clinicians and health systems fail to provide resources and strategies to facilitate their engagement.

The statement notes the growing urgency of these recommendations against the backdrop of workforce diversity challenges. Recent studies estimate that it would take 66 to 92 years of sustained doubling of Black and Hispanic medical student matriculants to address the deficit in the physician workforce to reach parity with the US population. Since the 2024 US Supreme Court decisions striking down the limited consideration of an applicant's race with the goal of creating a diverse student body, the prospect of racial parity is moving even further out of reach.

All committee members and authors submitted conflict of interest disclosures, and any potential conflicts were reviewed and managed in accordance with the American College of Obstetricians and Gynecologists' policy.

Source: ACOG Committee Statement