Health care executives' greatest concern in dealing with journalists is what they perceive as the media's lack of information and lack of understanding of health care issues. According to a survey to which 175 institutions responded, administrators perceive that they are not well prepared to deal with the media, they fear being quoted out of context, and they exhibit a lack of trust in the media. When the study data were examined according to hospital size and the presence or absence of a public relations function, the following relationships were observed: CEOs in large institutions are more likely than CEOs in smaller institutions to perceive that the media misunderstand health care issues. The degree to which lack of trust in the media and quoting out of context were cited as problems declines as bed size increases. The presence of a public relations function in the institution does not eliminate CEO's perceptions of miscommunication. Providers must take a strong stance in addressing the potential problems highlighted in the study. Seminars and printed materials should be created to update the media on current issues and to foster a sense of cooperation between the parties. Executives themselves must take advantage of continuing education programs that focus on developing communications skills. Efforts to resolve these problems are imperative, since continued dissatisfaction with the media ultimately will result in a misinformed or uninformed public.