This paper examines how the exchange of information in medical interviews is organized, and how that organization produces and constrains the negotiation of treatment decisions. The analysis is drawn from the verbatim transcripts of audio-taped practitioner/patient communications, information gathered from medical files, and other ethnographic materials. Twenty-one women were followed during a two-year period in a paired set of outpatient clinics (Faculty and Community Reproductive Oncology Clinics) in a teaching hospital. The following factors were examined: (1) the strategic use of language by practitioners and patients to negotiate treatment decisions; and (2) how the negotiation is produced and constrained by the specific organizational context in which it occurs, the practical concerns of the participants, and the asymmetry of their relationship. The linking of three levels of analysis in this study led to the observation that poor, minority, or powerless women are likely to receive radical procedures, even when these are not mandated on medical grounds. (AMH)