Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits

By Debra L. Roter; Judith A. Hall | Go to book overview

1
The Significance of Talk

This book is about doctors and patients and what goes on between them in medical visits. Most of what occurs is talk. By talk we mean what is said in the usual sense--the words that are used, the facts exchanged, the advice given, and the social amenities that tie the conversation together. But we also mean communication beyond words, the whole repertoire of nonverbal expressions and cues. The smiles and head nods of recognition, the grimaces of pain, the high-pitched voice of anxiety all give context and enhanced meaning to the words spoken. Despite its central role, for the most part this talk goes unnoticed. There are exceptions: a doctor pays deliberate attention to which questions to ask, and might take conscious note of a look of perplexity on the patient's face. A patient may phrase a question ahead of time or lament oversights in the description of symptoms. But generally the exchange is taken for granted, and participants have little sense that they choose how it develops or that it can be different than it typically is.

The perspective of this book is that talk is the main ingredient in medical care and that it is the fundamental instrument by which the doctor-patient relationship is crafted and by which therapeutic goals are achieved. Though physicians conduct physical exams and use blood tests, X-rays, medications, and much else to achieve therapeutic goals, the value of these activities is limited without the talk that organizes the history and symptoms and puts them in a meaningful context for both patients and physicians.

Our high regard for the role of talk is far from universally accepted. Historians of modern medicine have tracked the changing patterns of medical practice to reveal a fundamental shift in the centrality of talk to the care

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