Verbal exchanges in medical interviews: implications and innovations.

Medical interviews (consultations) are composed of verbal exchanges, complementary 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 principal exchanges are called Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/Contracts. We discuss how the verbal exchange structure contributes to understanding the confluence of patients' and clinicians' goals and expectations, clinicians' hypothetico-deductive method of reasoning during interviews, and establishing the patient-clinician relationship. We conclude by considering new exchanges that might make medical interviewing more effective and humane.