title: Verbal exchanges in medical interviews: implications and innovations.
abstract: Medical interviews (consultations) are composed of verbal exchanges, complementary categories of speech by patients and clinicians that tend to occur together. Patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The seven principal exchanges are called Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts. We discuss how the verbal exchange structure contributes to understanding the confluence of patients' and clinicians' goals and expectations, clinicians' hypothetico-deductive method of reasoning during interviews, and establishing the patient-clinician relationship. We conclude by considering new exchanges that might make medical interviewing more effective and humane.
authors.affiliation: East Boston Neighborhood Health Center, MA 02128.
authors.forename: S M
authors.initials: SM
authors.lastname: Putnam
authors.forename: W B
authors.initials: WB
authors.lastname: Stiles
mesh_terms: D003142:Communication; D006801:Humans; D007407:Interviews as Topic; D008487:Medical History Taking; D010817:Physician-Patient Relations