Communication with patients is the third most frequent issue leading to medical-legal advice calls involving licensed internationally trained physicians in Canada, according to the Canadian Medical Protective Association. That gap is not about competence. It is about adaptation.
Canadian healthcare has specific, well-established expectations around how physicians communicate: with patients, with families, and with care teams. These expectations are not always written down anywhere obvious, making the adjustment harder for physicians trained in different systems.
The good news: communication habits are learnable. Research from the Government of Canada’s physician communication training materials confirms that skills like active listening, checking understanding, and sharing decisions can be practised, refined, and improved at any stage of a career.
This guide covers what those habits look like in practice, why they matter in the Canadian context, and how you can start building them before your first day.
What you will find in this article:
- The communication norms Canadian patients and care teams expect
- Seven specific habits that build trust and clarity in Canadian clinical settings
- The most common communication mistakes IMGs make and how to avoid them
- Practical steps to start developing these habits now
What Canadian Patients and Teams Expect from Communication
Canadian healthcare culture places the patient at the centre of care. That phrase is used often, but it translates into specific expectations that may differ from what you experienced in training. Understanding those expectations is the first step toward meeting them.
A needs assessment of internationally trained physicians at the University of Ottawa found that IMGs consistently identified communication with patients, families, and colleagues as a top adjustment challenge, even when they were already licensed and practising. The issue was not language proficiency alone. It was the shift in communication culture.
| Expectation | What it looks like in practice | Common mistake |
| Patient-centred dialogue | Asking what the patient wants to know before launching into an explanation | Leading with clinical findings before asking about the patient’s concerns |
| Shared decision-making | Explaining options and inviting the patient to choose based on their values and situation | Presenting a single recommended plan without discussion |
| Plain language | Saying “high blood pressure” instead of “hypertension” throughout the conversation | Defaulting to medical terminology and assuming patients follow along |
| Cultural safety | Staying curious about the patient’s background rather than assuming shared understanding | Assuming patients from similar cultural backgrounds communicate the same way |
| Team communication | Briefing nurses, allied health, and colleagues clearly and respectfully | Communicating only with patients and bypassing the broader care team |
With more than 1 in 5 Canadians lacking a regular family doctor, care is increasingly delivered through team-based models. Clear, collaborative communication with the full team is not optional in this environment.
7 Communication Habits That Help IMGs Build Trust Faster
These habits are grounded in Government of Canada communication training for physicians and adapted to the specific adjustment challenges IMGs face in Canadian practice. Each one is observable and repeatable, not a vague attitude to adopt.
- Ask open questions before narrowing the conversation
Start every consultation with a broad, open question: “What brings you in today?” or “What has been worrying you most?” Let the patient speak without interrupting for at least 60 to 90 seconds. Canadian patients expect to feel heard before they feel assessed. Closing down the conversation too early signals that you are following a checklist rather than listening to them.
- Use plain language throughout, not just at the end
Plain language is not a simplification of medicine. It is a communication choice that keeps the patient in the conversation. Replace “myocardial infarction” with “heart attack,” “ambulate” with “walk,” and “contraindicated” with “not safe to take with your other medication.” The goal is that the patient leaves understanding what happened, what comes next, and why it matters.
- Check understanding using the teach-back method
Do not ask “Do you understand?” That question almost always gets a yes, regardless of whether the patient understood. Instead, ask: “Just so I can make sure I explained that clearly, can you tell me in your own words what you are going to do when you get home?” This shifts the responsibility for clarity to you, not the patient, which is exactly the right framing in Canadian care settings.
- Name emotions before moving to the next clinical step
When a patient shares a fear, a frustration, or a concern, acknowledge it directly before continuing. “It sounds like that has been really stressful” takes five seconds and changes the entire tone of the visit. Government of Canada physician training research found that patients who felt they had fully discussed their concerns with their physician were three times more likely to recover after one year than those who did not.
- Present options, not just recommendations
Shared decision-making means explaining what the options are, what the trade-offs look like, and what the patient’s own preferences and values should factor into the decision. A phrase like “There are two ways we could approach this, and the right choice depends partly on what matters most to you” opens that conversation in a way that feels respectful and collaborative.
- Adjust your pace, tone, and non-verbal cues deliberately
Slow down your speech rate when delivering important information. Make consistent eye contact. Face the patient directly. Avoid crossing your arms. Use pauses after key points to give the patient time to process. These cues signal presence and safety in a way that words alone cannot.
- Practise cultural humility, not just cultural awareness
Cultural awareness is knowing that differences exist. Cultural humility is staying curious about the individual in front of you rather than applying assumptions based on their background. As the Canadian Paediatric Society states, only patients and caregivers can determine whether a care interaction felt culturally safe. That means your intention is not enough. The patient’s experience is the measure.
Key insight: IMGs report communication challenges even when treating patients from similar cultural backgrounds. The adjustment is not about language alone. It is about the habits that signal respect, clarity, and collaboration in the Canadian care context.
Common Communication Mistakes IMGs Make in Canada
Most of these habits are not instinctive at first. The following mistakes are common during the adjustment period, and recognizing them is the fastest way to correct them.
| Instead of this… | Try this |
| Launching into a clinical explanation before the patient has finished speaking | Ask an open question, then wait and listen before responding |
| Using medical terminology throughout the consultation | Translate every clinical term into plain language the first time you use it |
| Asking “Do you understand?” at the end of the visit | Use teach-back: ask the patient to explain the plan back in their own words |
| Moving straight to the next question after a patient shares a concern | Acknowledge the emotion first, then continue |
| Presenting a single treatment plan as the only option | Offer two or three options with a brief explanation of each |
| Rushing through the visit to stay on schedule | Use deliberate pauses after key information to signal that you are present |
| Assuming shared cultural background means shared communication style | Stay curious about each patient as an individual |
As noted in the Clarity Communication Coach article on earning trust with Canadian patients, speaking like a textbook, even with fluent English, can create distance that clinical knowledge alone cannot close.
How to Practise These Habits Before You Start Working
Reading about communication habits is a starting point. Building them takes deliberate practice. The Government of Canada’s Talking Tools II program was designed specifically to help practising physicians develop these skills through discussion, role play, and feedback, because passive learning alone does not produce lasting behaviour change.
Here are four concrete steps you can take now:
- Rehearse patient explanations aloud. Choose a condition you commonly discuss and practise explaining it in plain language without any medical terminology. Record yourself and listen back.
- Role-play a consent or shared decision-making conversation. Ask a colleague, friend, or coach to play the patient. Practise presenting two options and inviting a response.
- Use the Medical Council of Canada’s pre-arrival resources for internationally trained physicians. The MCC’s 2025 resource maps include guidance on patient-centred communication and cultural safety expectations specific to Canadian practice.
- Work with a communication coach who understands the Canadian healthcare context. Targeted feedback on your specific patterns, not generic communication advice, is the fastest way to close the gap.
The ITP Communication Mastery program at Clarity Communication Coach is designed specifically for internationally trained physicians entering Canadian practice, with coaching focused on patient-centred communication, cultural adaptation, and clinical conversation skills.
The Bottom Line
Communication in Canadian healthcare is not about sounding polished. It is about showing patients and colleagues, from the very first interaction, that you are safe, clear, respectful, and collaborative.
The habits in this guide are not instinctive for most physicians trained outside Canada. That is not a reflection of your ability. It is a reflection of how different healthcare communication cultures can be, even when the clinical knowledge is identical.
The key takeaways:
- Canadian patients expect to be treated as participants in their care, not recipients of instructions.
- The habits that build trust fastest are open listening, plain language, teach-back, emotional acknowledgement, and shared decision-making.
- Communication challenges are among the most common issues for licensed IMGs in Canada, and they are also among the most addressable.
- Practising these habits before you begin is far more effective than adjusting under pressure once you are already in clinic.
