VERBAL EXCHANGES IN MEDICAL INTERVIEWS - IMPLICATIONS AND INNOVATIONS

Medical interviews (consultations) are composed of verbal exchanges, c omplementary categories of speech by patients and clinicians that tend to occur together. Patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The seven pri ncipal exchanges are called Exposition, Closed Question, Checking, Dir ection, Inquiry, Explanation, and Instruction/Contracts. We discuss ho w the verbal exchange structure contributes to understanding the confl uence of patients' and clinicians' goals and expectations, clinicians' hypothetico-deductive method of reasoning during interviews, and esta blishing the patient-clinician relationship. We conclude by considerin g new exchanges that might make medical interviewing more effective an d humane.