More than a string of words

The study by Wright and colleagues in this issue of BMJ USA (p 303) presents the perspectives and experience of a small sample of patients with breast cancer as they engaged in the care process with their physicians. As the investigators note, their conclusions depart in substantial ways from current knowledge regarding the positive effects of patient-centered communication in oncology visits. In an attempt to understand how so dramatic a departure from the literature may be explained, conceptual weaknesses of the study and its interpretation of findings—rather than limitations of the established literature—have emerged. The investigators' primary conceptual errors were equating isolated segments of the medical dialogue with meaningful representations of communication skill, and further, attributing the source of perceived relationship characteristics to patients' dependency needs rather than to communication.

The method of inquiry and sources of data for the study were unusual. Women with primary breast cancer, ranging in disease stage from histological diagnosis after surgery to follow-up …