Doctors' communication of trust, care, and respect

Editor—The discussion section of the paper by Burkitt-Wright et al on doctors' communication of trust, care, and respect in breast cancer is extraordinarily muddled.¹ The first paragraph seems to imply that communication style is not of particular concern to patients but then goes on to emphasise the importance of trust, empathy, and autonomy—all of which depend on effective communication.

After asserting that their analysis is more sensitive to patients' needs than everyone else's, the authors make several sweeping and paternalistic generalisations about patients, referring the reader to a set of equally paternalistic, and at times positively misleading, communication rules (boxes 1-3). They even imply that fostering blind faith is more desirable than imparting honest information.

In the sixth paragraph, the most confusing of all, they say that giving patients “the option” (what option?) is better than giving them choice (what on earth do they mean?), but they propose that this has nothing to do with empowerment or shared decision making. They speak approvingly of patients' autonomy but not of determining role preferences, sharing reliable information, discussing more than one option, being open about uncertainties, clarifying values, or any other facets of a mature approach to clinical decision making.

How did this one slip through?