based on principles of counseling and involves addressing preventive health behavior changes and adhering to chronic disease regimens (Miller and Rollnick 1991). Motivational interviewing requires working empathically with patients to help them cease unhealthy behaviors and adopt those that are more consistent with health and well-being. Achieving patient-centered care on a broad scale requires intense focus on development of communication skills during medical training and residency programs, as well as ongoing evalu- ation of the success of these programs in teaching valuable communication skills. Understanding what patients wish to convey Physicians’ receptiveness to their patients’ communication can provide therapeutic care by serving multiple purposes: opening the lines of communication, enabling physicians to develop stronger relationships with patients, and determining treatment regimens that patients ﬁnd more manageable and to which they are able to adhere. As research demonstrates, older patients tend to discuss biomedical topics more frequently than psychosocial topics because they often have a number of biomedical issues that need attention in the medical visit (Greene et al 1987). Studies have shown consistently that the discussion of psychosocial topics is extremely important in the care of older patients. Awareness and care of the older patient as a whole person, and attention to his or her psychological, social, and emotional experience are critical to effective disease management (Adelman et al 1992, 2000). Patients’ active participation in their treatment, their involvement in medical decisions, and their voicing of preferences for many aspects of their care can be essential to both patient satisfaction and patient adherence. Active communication increases patients’ knowledge of their condi- tion, allows them to convey important information to their physicians, and improves the process of care. Studies show that patient participation is inﬂuenced by patients’ charac- teristics; greater participation is offered to patients who are active participants themselves and have a higher education level (Street et al 2005). Female patients tend to be more outspoken about their care, while non-White patients have been found to demonstrate fewer behavioral attempts at participation with their physicians, resulting in less effective communication (Street et al 2005). The process of physician-patient joint decision-making about medication regimens is essential to patient adherence. Studies show that if physicians and patients together decide Clinical Interventions in Aging 2007:2(3) Physician-patient communication what medications will be taken, how often, how long, and on what schedule, as well as how to deal with side effects and other challenges, adherence is much better than if patients are simply told what to do and left to their own to work out how they will adhere (Lin et al 1995; Chewning and Sleath 1996; Jahng et al 2005). This is particularly important with older patients, who may have problems remembering multiple medical regimens that are confusing and can conﬂict with one another (Dunbar-Jacobs and Schlenk 2001; Ownby et al 2006). Participation in decision making has been found to vary considerably with several aspects of the psychosocial environment of care, including the participants’ skills in communication, patients’ trust in the provider, and patients’ level of knowledge and conﬁdence in themselves (Belcher et al 2006). In the medical visit, physicians sometimes inadvertently erect barriers to effective and efﬁcient transmit- tal of information with their patients. These barriers include interrupting and rushing patients. In research on patients’ opening statements in their visits, physicians were found to interrupt patients on average 23 seconds after they began to talk (Marvel et al 1999). Studies of physicians’ interactions with elders have shown that patients are uncomfortable and unable to talk about psychosocial issues when they feel rushed through the visit and sense that their physician is not interested in what they have to say (Greene and Adelman 1996). In a focus group and survey study of older men and women, time constraints on visits and the feelings of being “rushed” were offered frequently as barriers to effective communication (Vieder et al 2002). Empathy in the care of older patients Empathy involves a socio-emotional connection between physician and patient and is vital for developing and sustaining the therapeutic relationship (Roter and Hall 1989). The American Board of Internal Medicine (ABIM), which can be a driving force behind elements of the US medical school curriculum, deﬁnes physician “humanism” as including the qualities of empathy as well as trust, integrity, respect, and compassion for patients. Carl Rogers, the eminent humanistic psychotherapist, described empathy as adopting another’s perspective and “walking in their shoes” for a time, to view life from their point of view (Raskin and Rogers 1989). The ability to empathize is an active process. Unlike sympathizing, which involves feeling sorry for another’s circumstances, empathy requires actively trying to understand another’s experience of the world, and conveying this understanding to him/her through words of comfort 457