In Reply Dr Smulders takes issue with our comment that patients’ ratings of communications skills may have limitations. We did not intend to suggest that patients were not important evaluators of communication. Patient perceptions are crucial. However, when the conversation involves topics that patients do not want to talk about, or find uncomfortable or sad, patient ratings may have limitations as an outcome measure for several reasons.
First, patients may have little experience with other clinicians to help form a judgment. Second, their own emotions raised by the conversation may be more influential in their rating than what the clinician said or how he or she said it. Third, some patients may judge optimism preferable to straightforward discussion of prognosis, even when it is unrealistic or leads to misinformation. A recent study found that, for patients with advanced cancer, better understanding of their prognosis was associated with lower ratings of physicians’ communication.1
Curtis JR, Back AL, Engelberg RA. Training for Effective Patient Communication—Reply. JAMA. 2014;311(13):1356-1357. doi:10.1001/jama.2014.1475