Considerable research suggests that patients and physicians often perceive aspects of the medical interview quite differently. Despite extensive research into physician-patient communication, virtually no attention has been given to assessing patients' and physicians' perceptions of communication competence during the medical interview. The purpose of this research was to determine the extent of agreement between physicians and patients on what behaviors constitute competent patient communication. The results indicate that there is considerable agreement between physicians and patients on the categories of competent patient communication. However, there is little or no evidence for agreement at the dyadic level on the occurrence of competent patient communication. Moreover, there is little evidence that physicians' and patients' perceptions of competence correlate with patients' actual discourse. These results are discussed with respect to implications for future research on patient communication skills training interventions.