Debra L. Roter and Judith A. Hall. 224 pages. Westport, Connecticut: Auburn House; 1992. $45.00.

As the scientific method is increasingly applied to the analysis of patient-doctor communication, one can begin to appreciate the science behind the art of medicine. Understanding the components of patient-doctor dialogue, and the factors affecting them, lays the groundwork for improving patient (and doctor) satisfaction and potentially patient care outcome. This is the premise Roter and Hall present in Doctors Talking with Patients/Patients Talking with Doctors, and they defend it with reasonable evidence.

Written for doctors and patients, this text will be most valuable to persons interested in the medical interview, including teachers, sensitive practitioners, and those who analyze the process. Well referenced, it outlines an organized review of patient and physician characteristics that affect the style, content, and even length of dialogue. The discussion of the effect of the patient's or physician's sex on either's behavior is particularly well written.

A section on the effect of patient age is intriguing, although it could have been more cautious in its conclusions. The author's studies from private practice as well as from clinic settings and their observations are widely applicable; specific exceptions are noted when the setting accounts for a difference. Patterns of talking and models of patient-doctor interaction (such as paternalism, consumerism, mutuality, and default) are discussed in terms of efficacy and appropriateness in given situations (such as increasing severity of illness). This background information precedes an optimistic but credible review of the associations of effective communication with quality of care and patient outcome; this is followed by a closing section on suggestions for improved effectiveness.

If the premise Roter and Hall defend is true, it represents a powerful and basic tool that deserves far more time in medical education curricula, from undergraduate through postgraduate training (and even into continuing medical education) than is now allocated. Their case is strong but I suspect they are preaching to the converted. Additional supporting evidence will no doubt be required before granting agencies and biotechnically oriented medical school faculties accept and act on it.

In the meantime, demystifying the process of patient–physician communication can only serve to augment our appreciation of its meaning and power. This book is a well-written reference on the state of the art and science.