Are there times when you might want to consider firing a doctor?

Probably, says Dr. Bob Arnold, director of the Institute for Doctor-Patient Communication at the University of Pittsburgh School of Medicine.

"I have some people who don't feel they can talk to their doctor, that he doesn't listen to them," said Dr. Arnold, who practices palliative care at UPMC's Presbyterian, Shadyside and Magee-Womens hospitals. "I think in those cases, if you can't negotiate that, you might want to think about getting another doctor, and it's not a bad thing to think about getting another doctor.

"You need to find one that works for you and not all doctors fit all patients."

For example, he said, some patients want all the information available about their conditions and treatment; others simply want to be told what to do. Either is fine, as long as the doctor understands that and cooperates.

But the cooperation must be reciprocated.

"I don't think you can be a good doctor if you don't know your patient ... what kind of people they are and what makes them tick and what they like," Dr. Arnold said.

But it can be just as hard for a doctor to get to know a patient that well. For that reason, many medical schools, including Pitt's, mandate classes in doctor-patient communication.

At Pitt, medical students take their initial class during their first year and another in their second. The heart of the courses is role-playing with actors, who are partially scripted to cover situations the students eventually will face in offices or at bedside.

"They need to know how to get information from patients, what's needed. ... They need to make a human connection with them to understand what the patient is going through," said Dr. William Cohen, director of the Down Syndrome Center at Children's Hospital of Pittsburgh of UPMC, who began teaching the first-year course when it was instituted in 1980. The advanced course was added three years ago.

"It's not just what you ask but how," he added.

Pitt second-year med student Rebecca Taylor English studied communications as an undergraduate. Nevertheless, she said, she found the med school courses very valuable.

"I think the most important thing we learned is how to listen," she said. "Even medical students who are already talented listeners can have benefitted because we learned techniques and strategies" for different situations. ...

"It was really helpful because we medical students are all unsure of ourselves and a little self-conscious about asking the tougher questions, invading our patients' privacy," Ms. Taylor English added. "It's a very different kind of conversation with a patient than with a friend or family member because you already have intimacy established with them."

But questions like those involving domestic violence or even the patient's sex life need to be answered because reticent patients sometimes don't give the real reason they have made an appointment.

"It's difficult to talk about erectile dysfunction," she said, giving an example of one common problem men are embarrassed to disclose.

"[Role-playing] helped us get used to asking questions in a nonjudgmental way so the patients can be comfortable to provide information about, say, substance abuse or sexual assault."