Success in medical therapeutics depends heavily upon whether the doctor and patient adequately communicate their expectations of one another. Communication serves as the mechanism for the necessary, constant renegotiation of their interpersonal contract if the therapy is of more than brief duration. This implicit contract is necessary for assuring a sufficiently equitable, gratifying relationship that each will do his part to accomplish therapeutic success. This paper discusses characteristics of effective doctor-patient communication, the process of “spiraling down” or progressive failure of communication, and the manner in which such a process may be reversed. Immediate attention needs to be given to the teaching of communication principles in programs of medical education.