Difficulties and disasters occur often in physician-patient communication. Dr. Fred Platt argues that it is the physician's job to recognize these difficulties, sort them out, and attempt to repair them. Furthermore, he states that "conversation repair is as essential as the diagnosis and therapy of organic disease if one is to be a real doctor." Instead of blaming difficult patients for communication difficulties, Platt asserts that the physician is responsible for repairing broken conversations.

The book is easy to read because it is written as a series of 53 case discussions rather than as a traditional textbook. The cases are based on material gathered by Platt from his own practice, from his colleagues, and from physicians attending workshops conducted by the Bayer Institute for Health Care Communication (formerly the Miles Institute for Health Care Communication).

The cases are grouped into seven categories: Discover Meaning, Effective Empathy, Acknowledgment, So What Else is New, The Database, The Doctor Did It, and Patience, Humility, and Compassion. Each section begins with a statement of a problem, then several cases are presented as patient–physician dialogues, and then solutions are suggested. One useful way to read the book would be to read the case, decide how you might respond, and then read the recommended solutions.

The sections can be read in any sequence, but it is helpful to read the first chapter initially, because it is there that Platt briefly discusses two important theoretical perspectives. One is the belief, after Mishler, that the language of the physician and that of the patient are both involved in the interaction. The other is based on the work of Kleinman, who suggested that physicians must understand not only the disease but also the meaning of the illness to the patient. To accomplish these goals, Platt suggests areas that should be added to the review of systems. These include asking about health hazards (such as alcohol intake, seatbelt use, and diet), health maintenance activities (such as exercise and cancer screening), functional abilities, medical-social-ethical issues, and character features (what sort of person is this?).

Suggestions are made on how to ask about difficult topics. The book would have been enriched if Platt had addressed how to communicate in difficult areas pertinent to disease, such as how to tell bad news. Perhaps this will be covered in a future edition.

This is an excellent book that could be used to teach medical students or to which practicing physicians could often refer. The only possible danger is that the solutions appear too simple, and thus the book might be used in a "cookbook-like" way, with the reader running the risk of missing the underlying thesis. However, if the reader understands the book's thesis and applies it in patient encounters, the number of conversations that need to be repaired should greatly diminish.