chapter  4
14 Pages

How Medical Interaction Shapes and Refl ects the Physician–Patient Relationship

ByDebra L. Roter, Judith A. Hall

Interaction is the fundamental instrument by which the doctor-patient relationship is shaped and through which medical care is directed. By interaction we mean talk-what is said in the verbal sense-the words that are used, the facts exchanged, the advice given, and the social amenities that tie the conversation together. But we also mean communication beyond words, the whole repertoire of nonverbal expressions and cues within which verbal transactions are embedded. The smiles and head nods of agreement, the grimaces of pain, the high-pitched voice of anxiety, the rapid fi re delivery of questions critical to a diff erential diagnosis, or the calm soothing tones of comfort and reassurance are all indicative of the communicated, but unsaid. These nonverbal expressions give context and enhanced meaning to the words spoken. It is here in the intersection of the said and the unsaid that the relationship between patient and physician is forged and interpersonal dominance, respect, liking, or trust are established.