• Patient-centred care
• information technology
• evidence-based medicine
• healthcare quality improvement
• patient safety
• diagnostic errors

The Institute of Medicine identifies patient-centred care as one of the essential elements of high quality care.1 They define patient-centred care as ‘respecting and responding to patients’ wants, needs and preferences, so that patients can make choices in their care that best fit their individual circumstances'. Studies demonstrate that patient-centred care is associated with improved healthcare outcomes, particularly in patients with chronic diseases.2–8 It seems as if it would be both important and easy to deliver this kind of care. But, in fact, it is very difficult to do well.

Patient-centred care requires physicians and other healthcare providers to have the communication skills to elicit patients' true wishes and to recognise and respond to both their needs and their emotional concerns. As much as any technical skill, communication is a sophisticated procedure—one that needs to be taught and honed throughout one's career.

Patients assess the quality of their care largely through their experiences of talking with their physicians. When patients feel that the physicians listen carefully, understand their needs and provide information in a clear fashion, they are most likely to be satisfied with their care. As in the article by Fossli Jensen et al,9 most patients who experience this type of care will rate the physician highly on any type of patient satisfaction questionnaire.That said, all patient satisfaction measurement tools tend to generate highly skewed results, with patients assigning highly positive ratings to most clinical encounters. However, when patients feel the physician rushed through …