Despite widespread belief that psychosocial processes may be important in disease etiology, attempts to document the role of such factors in epidemiologic studies have led to conflicting and often confusing results. It is the thesis of this paper that this is largely a result of inadequacies in our theoretical framework. The point of view is presented that this stems from an uncritical subscription to and often erroneous interpretation of “stress” theory, a failure to recognize that psychosocial processes are unlikely to be directly pathogenic (in the way that, for example, a microorganism is) and unlikely to be unidimensional. An alternative point of view with data from animal and human studies is presented, and the implications for research strategy and the delivery of health care are discussed.

Forty-six practicing physicians and 357 patients with diabetes mellitus or congestive heart failure were the subjects for this study, which focuses on the impact of medication regimen and doctor-patient communication in affecting patient medication-taking behavior and physician awareness of these behaviors.Four types of medication errors were defined: omissions, commissions, scheduling misconceptions and scheduling non-compliance. The average error rates were 19 per cent, 19 per cent, 17 per cent and 3 per cent, respectively. The combined average error was 58 per cent; scheduling non-compliance on the part of the patient was a minor component.Specific aspects of the medication regimen were associated with increased errors: (1) the more drugs in-

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