Patients value how their doctors communicate with them.1 Technology has evolved rapidly in medicine, leading to important advances in healthcare. However, this cultural evolution has created a mismatch between how we are evolved to communicate and how we actually do.2 Today, doctors must interact with technology extensively—computers, monitors, devices, etc.—while also trying to interact with their patients. Since we are evolved to value face-to-face communication and to seek connection with our doctors—with our trusted healers—preventive measures are needed to preserve effective communication in medicine.

If you have been a patient or have visited a healthcare setting recently, you may have noticed that doctors spend surprisingly small amounts of time communicating directly with their patients.3 When they do interact, doctors may be distracted by cell phones, pagers, monitors, computers, devices, and other technologies. Doctors may also appear rushed, hurrying around to get work done and move on to the next thing. For patients receiving care in these environments, it can be frustrating to figure out how to connect with doctors to share, discuss, and plan.

For example, imagine that you are a patient hospitalized for an infection. You do not feel well. You may be confused about what is going on and who is doing what to help you get better. Early in the morning, a doctor enters your room (unannounced), asks a set of questions (many of the same questions that you were asked in the emergency room), gets interrupted by his cell phone (it is his pager), and then scurries out of the room. As the dust settles, you reflect and realize that you have more questions to ask, that you have concerns to share, and that you are unclear about the steps ahead. Perhaps more importantly, you do not feel connected to your doctor.

What could be done about this?

Evolutionary mismatch provides a valuable lens for viewing this challenge. Cultural evolution created technologically-advanced contexts that make it difficult for doctors to communicate with patients in manners concordant with our evolved, ancestrally-familiar modes of communication (face-to-face, without extreme time constraints, etc.). Given these known modern constraints, one preventive approach to preserving effective communication is a mindfulness practice: behavioral awareness.

Return to the previous scenario, and imagine that you are the doctor rounding on the patient hospitalized for an infection. As this doctor, your encounter with the patient can be divided into five domains of behavior: (1) Hi (Entering); (2) Familiarize (Identifying); (3) Interact (Connecting); (4) Voice (Discussing); and, (5) Exit (Concluding). Now, envision progressing through each domain as you review the following communication checklist (within each domain, suggested behaviors, along with tools and techniques to do them, are included as illustrative examples):

The Hi-FIVE Communication Checklist (PDF here)This “domains of behavior” framework could be adapted to various clinical environments to match key behaviors to different contexts.

If doctors utilized this type of checklist as a mindfulness practice to support connecting and communicating with their patients, they might find that it helps them navigate the mismatches of today’s healthcare environments. Ultimately, perhaps the process of creating a customized checklist using a behavioral-awareness approach might be a personalized mindfulness activity that any doctor could do to improve his or her communication skills and preserve what both doctors and their patients value: effective, empathic communication.

Read the full Evolutionary Mismatch series:

  1. Introduction: Evolutionary Mismatch and What To Do About It by David Sloan Wilson
  2. Functional Frivolity: The Evolution and Development of the Human Brain Through Play by Aaron Blaisdell
  3. A Mother’s Mismatch: Why Cancer Has Deep Evolutionary Roots by Amy M. Boddy
  4. It’s Time To See the Light (Another Example of Evolutionary Mismatch) by Dan Pardi
  5. Generating Testable Hypotheses of Evolutionary Mismatch by Sudhindra Rao
  6. (Mis-) Communication in Medicine: A Preventive Way for Doctors to Preserve Effective Communication in Technologically-Evolved Healthcare Environments by Brent C. Pottenger
  7. The Darwinian Causes of Mental Illness by Eirik Garnas
  8. Is Cancer a Disease of Civilization? by Athena Aktipis
  9. The Potential Evolutionary Mismatches of Germicidal Ambient Lighting by Marcel Harmon
  10. Do We Sleep Better Than Our Ancestors? How Natural Selection and Modern Life Have Shaped Human Sleep by Charles Nunn and David Samson
  11. The Future of the Ancestral Health Movement by Hamilton M. Stapell
  12. Humans: Smart Enough to Create Processed Foods, Daft Enough to Eat Them by Ian Spreadbury


  1. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. Ochsner J. 2010 Spring;10(1):38-43.
  2. Temple University. “Let’s Face It, Man is Not Made to Communicate Electronically.” ScienceDaily, 30 July 2001.
  3. Becker G, Kempf DE, Xander CJ, Momm F, Olschewski M, Blum HE. Four Minutes for a Patient, Twenty Seconds for a Relative: An Observational Study at a University Hospital. BMC Health Serv Res. 2010 Apr 9;10:94.

Header image by Direct Relief via Flickr

Published On: March 20, 2019

Brent C. Pottenger

Brent C. Pottenger

Brent C. Pottenger, MD, MHA is a physician at Johns Hopkins. At the University of California, Davis, he earned a Bachelor of Science degree in Physiology and Financial Management for Healthcare, with a minor in Contemporary Leadership. He completed a Master of Health Administration graduate degree at University of Southern California. He graduated from the Johns Hopkins University School of Medicine and received The Samuel Novey Prize in Psychological Medicine. Then, he worked as a Healthcare Systems Leadership Fellow in the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.

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