The purpose of this research was to analyze oral communication patterns between patients with varying degrees of individual health literacy (how patients access, understand, and use health information) and their health providers. We analyzed a secondary data set of 68 patient--nurse provider audiotaped clinic encounters using REALM (Rapid Estimate of Adult Literacy in Medicine, a health literacy measure), correlations, and quantile regression to look at the use of provider dialogue components: closed-ended questions, open-ended questions, data gathering--biomedical, education/counseling--biomedical, data gathering--lifestyle/psychosocial, education and counseling--lifestyle/psychosocial, and checking for understanding. Patients with lower health literacy levels were asked more closed-ended biomedical and lifestyle/psychosocial questions than those with higher literacy levels. Providers did not check for understanding with patients at any health literacy level. Implications for health literacy and adult education in the medical setting, adult classroom, and community organizations are described.