Field of medicine: Sociolinguistics and medical sociology.

Format: Hardcover book.

Audience: Medical sociologists, ethicists, medical students and educators, and researchers in patient-health care provider communications.

Purpose: To explore the content and socioemotional impact of patient–physician conversation and apply theories of sociolinguistics to medical encounters. The book also illustrates techniques of physician conversation style that are most conducive to patient satisfaction.

Content: The book's eight chapters are grouped into four parts. The author first reviews existing research in analysis of the patient–physician discourse, discussing theories and methods. The second section explores quantitative analyses of communication, such as analysis of the number of questions asked during an encounter and the role of gender in discourse control. The third section examines more qualitative aspects of patient–physician conversation and the roles of questioning and story telling in the medical encounter. Sections 2 and 3 contain examples from the author's research. Finally, the author summarizes her research and makes recommendations for physicians to maximize patient control of the medical encounter. The author's research focuses on patients with debilitating chronic illnesses, such as cancer, and she discusses her own experiences with chronic disease.

Highlights: Reviews of existing studies in the field, which occur throughout the book, are wide ranging and informative. The author includes extensive transcripts of her own data to highlight dimensions of her discussion, which form a strong contribution to the literature. Existing research often quantifies data by type of communication rather than retaining the content and context of actual dialogue. The use of extensive examples is especially helpful to readers who may not have experience with techniques of qualitative data analysis. The author also argues that previous studies have dwelt almost exclusively on the elements of provider talk without acknowledging the considerable conversational control that patients exert. Her effort to consider conversation-the exchange of responses that have meaning only when considered as a whole-is a welcome addition to the literature.

Limitations: As the title clearly states, the author's focus is understanding how physicians and patients each attempt to dominate conversation during medical encounters. The author argues that patients can successfully control conversations ("claim power") without compromising the physician's ability to accomplish medical care; in fact, this sense of conversational control is an essential element of good medical care. The author states explicitly that patients who achieve control of conversation are more satisfied with their medical care and that this difference in conversational style can influence patient behavior and medical outcomes in chronic disease. Although this argument is thought-provoking, the author's conclusions could have been strengthened by a discussion of research that links patient satisfaction with compliance and medical outcomes.

Related reading: This book can serve as a stand-alone resource. Previous works in the field, such as Roter's Doctors Talking with Patients, Patients Talking with Doctors (Auburn House, 1992) and Hall and Tannen's Gender and Discourse (Oxford Univ Pr, 1994) provide contrasting styles of research and arguments to balance this book.

Reviewer: Ann C. Klassen, PhD, John Hopkins University School of Public Health, Baltimore, Maryland.