In Reply I would like to thank Dr Akwari for her thoughtful comments and interest in my recent article1 concerning communication skills. Dr Akwari pointed out that though I felt I did not receive real-time feedback during patient conversations, feedback was nonetheless there in the form of nonverbal cues.
It seems to me that there are at least 2 kinds of feedback: one from patients and/or families, and another from a mentor or senior physician. Obviously, it is important to recognize nonverbal cues, which continuously arise during conversations, as well as the verbal. Nonverbal cues often reflect the emotional state of the patient but may very well be reactions to my performance, in which sense, I agree that feedback is always there and “reflection-in-action”2 is crucial.
Nakagawa S. Communicating With Patients—The Other Side of the Conversation—Reply. JAMA Intern Med. 2015;175(12):1997. doi:10.1001/jamainternmed.2015.6254