Drs. Koval and Rousseau present useful perspectives on the role of physician-patient communication in palliative care. Dr. Koval emphasizes that pain is a multidimensional experience. I agree. The more global concept of "suffering" is helpful in this context [1]. Patients may still experience suffering even if their pain is adequately treated with narcotics. To help alleviate their patients' suffering, physicians should attempt to understand and help address its psychological, social, and spiritual aspects. Although, in most cases, physicians will play a relatively minor role in this "existential" healing effort, a practitioner's empathy, respect, and willingness to listen can sometimes have remarkable results for both patient and practitioner. For example, my encounter with Antonio was an important healing event in my life.

Dr. Rousseau points out that poor physician-patient communication arises not only from lack of empathy and respect for patients but also (and fundamentally) from poor interactive skills. I certainly agree, although empathy and respect are also learnable skills that should be included in medical curricula. In The Medical Interview, Marian Block and I [2] describe five common barriers to effective communication with dying patients. These barriers are our tendencies as physicians to deny defeat ("There is always a chance"); to filter the data (use of jargon to disguise the truth); to fear the patient's loss of hope ("The patient needs the will to live"); to keep an emotional distance ("Feeling feelings is unprofessional"); and to disappear when the going gets rough ("There is nothing I can do"). I agree with Dr. Rousseau that it will be difficult to improve palliative care until we begin addressing these issues in medical school curricula and postgraduate training.