Drawing on personal observations and on a study of patient reactions, this paper considers the problem of doctor/patient communication failure in the inner city clinic. It first discusses the role of dialect variation in communication failure, causes of communication failure in the medical interview, factors contributing to doctor/patient communication failure, and dialect and affective response. It then reports on an experiment in which 20 black patients in a Chicago clinic listened to a message that had been tape recorded by three doctors--a local white doctor, a local black doctor, and a foreign doctor--and rated the doctors on 19 personality, competence, and trustworthiness variables. The results reported reveal that the white doctor was perceived the most favorably on 15 of the 19 variables. The paper then provides possible interpretations of the findings based on findings of previous studies and on variables in the three tape recordings; discusses anomalies in the findings; and points to problems involved in attempting to generalize from the findings. It concludes by stressing that miscommunication in inner city clinics is a very real problem and by pointing out the need for doctors, patients, and clinic administrators to make conscious efforts toward improving the situation. (GT)