Negotiation as an integral part of the physician's clinical reasoning.

Recent interest in the clinical process and its teaching has been based on research which has more clearly defined what actually happens. However, the way in which the physician interacts with the patient has not been given enough emphasis. It is proposed that the concept of negotiation be added to the other components of the physician's activity in clinical reasoning. Negotiation stresses the essential personal equality between physician and patient and the necessity for agreement between them about the problem and its management before the clinical encounter can be successful. Patients may negotiate directly or indirectly. This is dependent upon their perceived power of negotiation. The power to negotiate is at its strongest in the ambulatory patient and at its weakest in the patient who is admitted to the traditional university teaching center. It therefore behooves university teachers to negotiate meaningfully with the patient in the teaching center. This will ensure that students and residents observe negotiation as an important aspect of the clinical process, avoid learning it painfully, if at all, in practice.