A previous study suggested that patientpractitioner agreement and follow-up in ambulatory care facilitates problem resolution as judged by patients. In this study in another medical practice, practitioner-patient agreement on what problems required follow-up was associated with greater problem resolution as judged by the practitioners regardless of the severity of the problems. In this study, patients did not judge problems mentioned only by themselves to be less improved than problems mentioned by both them and their practitioners. However, in this study more of the problems mentioned only by patients were mentioned in the note of the visit contained in the medicalThe initial process of care, recognition of patients' problems by practitioners, has received little attention in research although it is clear that all other processes (diagnosis, management, reassessment) depend upon adequate and accurate perception of the underlying reason for the visit. A growing literature, much of it from Great Britain,'-3 addresses this issue by analyzing the verbal interactions between doctors and patients and demonstrating patterns of communication that are intuitively considered dysfunctional. There also has been more systematic study of the gaps in recognition of patients' problems and of their impact on patient care. Accurate recognition of patients' problems is associated with better understanding on the part of patients,4'5 more compliance,6'7 and better outcomes.8'9 Practitioners do better at recognizing patients' problems when there is continuity of care.'0 Medical records specifically designed to improve information recognition also facilitate problem-recognition by practitioners. "-'3Roter showed that professional dominance of the practitioner-patient interaction could be reduced by encouraging patients to express their problems niore forcefully.'4 In a