HEALTH PSYCHOLOGY, 1982, 1 (4) 315-336 EMPIRICAL CONTRIBUTIONS Verbal Exchange Structure of Initial Medical Interviews William B. Stiles Miami University Samuel M. Putnam Departments of Medicine and Epidemiology University of North Carolina at Chapel Hill Mary Casey Jacob Department of Medicine University of North Carolina at Chapel Hill Speech acts by physicians and patients in medical interviews can be grouped into verbal exchanges, which correspond to distinct medical tasks. Speech acts, measured by a verbal response mode (VRM) coding system, were coded from transcripts of initial medical interviews by physicians with 115 female pa- tients in a hospital walk-in clinic. Factor analyses of VRM frequencies in three interview segments—the medical history, the physical examination, and the conclusion—revealed four or five verbal exchanges in each segment. Some ex- changes appeared to correspond to major medical tasks of the interview, such as (1) listening to patients' exposition and probing for specific data in the history, (2) directing patients through diagnostic procedures and inquiring about subjective reactions in the examination, and (3) giving medical informa- tion and prescribing a therapeutic regimen in the conclusion. Other exchanges appeared to serve maintenance functions, such as informative commentary on This project was supported by grant number HS 03040 from the National Center for Health Services Research, OASH. We thank the patients, physicians, and nursing staff of the North Carolina Memorial Hospital walk-in clinic for their cooperation. We also thank Dennis B. Gillings, Barbara S. Hulka, and Sherman A. James for their counsel in planning and conducting this study, and James E. Orth and Leonard G. Rorer for their comments on drafts of this article. Send reprint requests to William B. Stiles, Department of Psychology, Miami University, Oxford, Ohio 45056.