Studies of doctor-patient interaction.

Discussion between doctors and patients has long been regarded as the vehicle by which much of the curing and caring of medicine is conveyed. Sometimes regarded as the art or heart of medicine, its importance was well noted in antiquity and is recognized in modem times. However, it is only since the mid-1960s that the actual dynamics of the therapeutic dialogue have been observed in any systematic manner and that an attempt to recast this aspect of medicine as science has been made. The evolution of methodological and technological sophistication has made observation and analysis of the medical visit easier over the years, and, indeed, the number of empirical studies of doctor-patient communication doubled between 1982 and 1987 to over 60 (47). Several reviews of this body of work have been undertaken (28, 39, 51,55, 57), but a resulting synthesis has been lacking; this is a difficult body of work to review. The predominantly exploratory nature of this research, which is largely of the kind in which everything gets correlated with everything else (24), contributes to an overwhelming number of results with which to contend. The results appear so confusing that Inui & Carter (28), in reviewing this literature, characterized the findings as a "Rorschach test" for readers in which overall interpretations are as apt to reveal something about the reader as about the results themselves. We have elected, therefore, to supplement a selective review of the litera-