Effective healthcare professional–patient communication is necessary to ensure not only that the patients' problems and concerns are understood by the healthcare professional (HCP) but also that relevant information, advice and treatment is received and acted upon by the patient. HCP–patient communication has been the object of considerable research, which has attempted not only to describe the interaction processes involved but also to show how these affect a range of patient outcomes. Early research revealed quite high levels of patient dissatisfaction which were often associated with insufficient information, poor understanding of the medical advice and subsequent reluctance or inability to follow recommended treatment or advice (Korsch & Negrete, 1972). The development of relatively unobtrusive audio- and video-recording techniques allowed researchers to obtain an ‘inside view’ of the consultation and many studies have analyzed the process of the consultation and attempted to relate process variables or characteristics to outcome. However, these studies, while identifying important themes, have not always been successful in making clear links between process and outcome (Stiles, 1989). One reason for this is that patients vary in their expectations and preferences. As a result, many current frameworks for understanding HCP–patient communication (e.g. Friedrikson, 1993) are based on the relations between inputs (i.e. the attitudes, beliefs, expectations, etc., which patient and HCP bring to the consultation), process (the nature of the encounter) and outcome (the short and longer-term effects on the patient).