Verbal exchanges in medical interviews: implications and innovations.
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.
Putnam
S M
SM
East Boston Neighborhood Health Center, MA 02128.
Stiles
W B
WB
D003142:Communication; D006801:Humans; D007407:Interviews as Topic; D008487:Medical History Taking; D010817:Physician-Patient Relations