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This study reviews nine studies that triangulated quantitative patient surveys with qualitative methods, and 15 studies that used open-ended questions as a supplement. Closed-ended questions seem systematically to minimize and conceal patient criticism. The reason is not a traditional validity problem, but rather that patients are cautious with criticism unless the method allows them to be very specific. The patients’ evaluation practice seems to reflect society’s embedded norms for interaction between professionals and patients. Experience with open-ended questions indicates that these may expose relevant potentials for improvement from the perspective of the patients. So far this possibility has, however, only been used to a limited extent even if it may make patient surveys more patient-centered. Closed-ended questions may show differences between different groups of patients and different points in time, but they do not indicate the level of satisfaction. It is recommended to combine closed-ended and open-ended questions. This is especially important in specialties with diverging opinions about the character of the illness, and in areas with new developments as for example changes in the organization or introduction of new methods of treatment.

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