THE PROBLEMS of co-ordination, and hence of communication, within the National Health Service, have long been recognised, and some studies have shown the effect of poor co-ordination both within the service and between it and other services.1 Yet there have been very few studies of the methods of communication used, Shawl made a study of communications and relationships between hospitals and general practitioners. He made a number of practical proposals about the arrangements for making appointments, and the transmission of reports. He also found that teachers in medical schools tended to stress the defects of general practitioners, rather than their virtues, to the detriment of relationships between them. R e v a d has examined communications inside hospitals. Rodgers and Dixon' and Jeffries5 showed the lack of contact between general practitioners and other social services. But none of these studies has been based on the concepts of communication theory, and little reference has been made to studies of other large organisations. As a result, there has been a tendency to attribute breakdown in communication to the idiosyncracies of the National Health Service when factors common to other organisations might be involved. For example, Leavitt and Mueller's studies showing the importance of feedback in the transmission of complex information are clearly of relevance to the medical fie1d;O so too are studies of the effectiveness of different communication networks,' and of the effects on communication of cognitive similarity, i.e. similarity

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