The art of effective physician-patient interaction is better learned by observing experienced clinicians than through pedantic lectures or textbooks. Long-term apprenticeships are a thing of the past, and today's exposure to widely varied attending physicians rarely offers the opportunity to learn the subtleties of gratifying interaction. Conversation Repair allows the reader to observe the ways in which one experienced clinician deals with various troublesome challenges.

Learning to deal comfortably with "difficult" patients is the goal of Conversation Repair. During his more than 20 years of clinical and teaching experience, the author has had his share of frustrating encounters. In this book, he has honestly and thoughtfully confronted his shortcomings and those of the students and residents he teaches, and he offers his perspectives on overcoming interpersonal obstacles.

Fifty-three cases compose the heart of the book. Each vignette focuses on a difficulty in the clinician-patient relationship (or, in a few instances, on difficulties between clinicians). A brief recreation of the physician-patient dialogue highlights the problem; the reader is then asked to formulate a way to "repair" the problem before the author offers his approach. The spectrum of interpersonal problems discussed includes patients who are talkative, angry, unfocused, unwilling to get well, or just plain mysterious.

Not every issue has a definitive answer; in fact, the author admits that some difficulties between clinician and patient have no really satisfactory solution. But many obstacles do yield to better gathering of data, stepping back from a conflict to gain a new perspective (including the patient's point of view), searching for a hidden agenda, empowering the patient, identifying the clinician's vulnerabilities and shortcomings, and seeking new ways to communicate. The author's theme is that "difficult" patients are often reflections of failed communication.

Although at times the author tends to pontificate, his style is generally lucid and entertaining. A list of references offers suggestions for exploring topics. Unfortunately, the index is totally inadequate—it is simply the Table of Contents in alphabetical order, making it impossible to return to a case or search a topic.

For practitioners who have mastered effective communication skills, matching wits with the author will be fun. For clinicians who acknowledge their interactional shortcomings, new approaches will be suggested.