other words, medical care involves more than correct diagnosis and recom-
mendation of treatment. Social factors precede diagnosis, for they are in-
volved in the very experience and definition of illness and the willingness to
seek care. Social and psychological processes imbue every event and deci-
sion in medical care. Medicine is not a narrowly defined technical enterprise,
no matter how sophisticated the technologies become. Many doctors and
patients undoubtedly recognize how profoundly social the process of medical
care is, but probably few, in either group, are aware of how well developed
our scientific knowledge of that process is.

In writing this book, we hope to introduce this important body of research
to those who will profit from it most--the doctors and patients who have
been its subject.

The book is not an attack on doctors, any more than it is an attack on
patients. Doctors and patients share the responsibility for shortcomings in
their relationships, and together they can work to correct them. If we take it
as our job to communicate these shortcomings, we do so in the hope of
enhancing the medical experience for both.

Our focus in writing this book is, as the title suggests, talk. The term talk is
meant broadly, to include all of the face-to-face communications, including
nonverbal, that are exchanged between doctors and patients. We use the vernac-
ular word doctor to refer to a person with an M.D. or D.O. degree. The word
physician is interchangeable. We sometimes also refer to providers and practi-
tioners, terms that include doctors along with other professionals who provide
health care, such as nurses, nurse practitioners, and physicians' assistants.

Underlying the work presented in this book is the confidence that doctors
and patients can change the nature of their interactions. If we accomplish
nothing else, we hope to encourage doctors and patients to reflect on the
possibility of eliciting new repertoires of response from one another. This
requires gaining insight into how each typically behaves, developing an
agenda for what an improved relationship would look like, and recognizing
that a person tends to act consistently with the other's expectations. Our goal
is to convey enough knowledge to convince doctors and patients of the
necessity for change, and to promote a sense of empowerment in them. We
do this in what we hope is a logical manner, drawing on findings from our
own research and that of others.

The book is divided into four parts. Part I is descriptive in nature and
designed to reflect what is known about how doctors and patients typically
behave from a variety of vantage points.

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