This article uses a 1974 study of doctor–patient communication from Christopher Candlin, Clive Bruton and Jonathan Leather as a starting point to trace how miscommunication, misunderstanding and communication failure have been treated in the applied linguistics of professional practice since then. The study helps us notice the tension between seeing miscommunication as a problem of skills, and seeing it as part of a situated process in a wider context of institutional practices. In reading the literature on misunderstanding through this 1974 study, I focus on how the act of miscommunication is identified, who sees it as a misunderstanding, what is at stake and how an event, labeled as a misunderstanding, is retold in a new context.