In this article, the author clarifies and comments further on some of the issues raised in John Pill's response to her commentary on "English Proficiency Tests and Communication Skills Training for Overseas-Qualifies Health Professionals in Australia and New Zealand" in the recent special issue of "Language Assessment Quarterly" (Wette, 2011). The main aims of her commentary in this issue were to outline a particular context in which tests of English proficiency are used to screen overseas qualified health professionals seeking local registration, and to argue for a more diagnostic approach to assessments of proficiency in English for this group, for a broader view of what constitutes effective communication skills in healthcare contexts and, if needed, the provision of publicly funded instructional support to assist overseas qualified health professionals to achieve their goals. In New Zealand and Australia, the International English Language Testing System (IELTS) and the Occupational English Test (OET) are currently the only means by which the communicative abilities of overseas qualified health professionals are assessed from a language perspective. The author's view, shared by the overseas qualified health professionals in Read and Wette (2009), the international medical graduates who commented in Submission 101 to the Australian Parliamentary Inquiry Into Registration Processes and Support for Overseas Trained Doctors (2011), and a number of teachers of English for medical communication (Submissions 50, 63, 64, 95, 110 and 152), is that although these tests are rigorous assessments of academically oriented linguistic competence, they do not directly assess the kind of pragmatic and discourse competence that health professionals need to master in order to communicate effectively with patients or clients. The sources cited also maintain that in recent years the passing standard of English proficiency has been raised, and that it is now unreasonably high. As a result, health professionals can spend significant amounts of time, money, and energy striving to meet a standard and type of English proficiency that many perceive to be of limited usefulness to their future careers. In outlining these issues, the author discussed various aspects of both IELTS and OET. However, her intention was not to criticise either of these per se, as their quality as English proficiency tests is well established. The OET featured more prominently in her discussion because it is a contextualised specific purpose test, which means more research and discussion has been published on what it is able to measure and what its results indicate in respect of professional communication skills. Her comments were actually directed to what IELTS and OET represent to medical registration bodies and the purposes for which they are currently used.