Observations on methodological and measurement challenges in the assessment of communication during medical exchanges.

Reviews of medically related communication research clearly demonstrate that physicians have been studied far longer and more frequently than any other type of health care provider; nevertheless, much of what is known is limited to what is said by primarily male, White, primary care physicians during the delivery of outpatient care. Furthermore, the majority of communication studies assess medical communication largely as a physician monologue with only occasional attention to what an individual patient may say back. Limitations of the literature are obvious. Little is known about the role of a patient companion during medical visits or the consequence of patient and provider race and gender concordance (or discordance) on interpersonal dynamics. We do not know very much about relationships under stress or how patients and providers respond in those rare, but critically important events when observational techniques in the natural setting are logistically impossible or otherwise inappropriate. While it is difficult to argue with the basic tenets of ecological validity and the value of authentic settings for observational studies, the contribution of simulations and analogue studies to our understanding of medical dynamics is worthy of consideration. This essay explores methodological and design challenges related to broadening the study of medical communication through more creative and thoughtful study designs.