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What patients understand from medical consultations and the processes by which they understand are of considerable clinical and theoretical interest. Empirical research about patients' understanding has been restricted, however, by measures which are inadequate when compared with the depth and complexity of sociological and social anthropological theories of medical consultations. One consequence has been that sociological and social anthropological ideas have been considered largely inappropriate for practical application. A "third party" method of defining the information universe which patients might be expected to grasp from the consultation and of assessing three levels of patient "understanding" is proposed. The method involves judgments about the content of what doctors actually say to patients and what it might mean. Such methods inevitably involve specifying values and therefore make apparent problems of validity which are only implicit in methods where such judgments appear to be avoided. Evidence is presented to show the approach can be reliably conducted. Moreover, the measures described discriminate groups of patients in interesting and predictable ways and help to deepen our ideas about the determinants of cognitive outcomes in medical consultations. [ABSTRACT FROM AUTHOR]