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Full Access Closing Surgeon-Patient Consultations

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Closing Surgeon-Patient Consultations

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Closing an encounter is a co-constructed activity through which participants conclude verbal and non-verbal action in a way that allows each to raise any matters they wish prior to the termination of the encounter (West, 2006). Although medical encounters are often time restricted, the scheduled length of the appointment “does not determine just when or how such a visit will be brought to a close” (West, 2006: 379). There are, however, points within the consultation where closing becomes a relevant activity. In this article, I examine these points in surgeon-patient consultations. There are seven types of surgeon-initiated pre-closings found in the data presented here. These are: final-concern sequences; arranging surgery; referring back; referring on; arranging diagnostic testing; organising a follow-up; and instructions regarding front desk paperwork. There is also one instance of patient-initiated possible pre-closing, which is also described. After an analysis of these seven types, there is also an analysis of the types of non-minimal responses that can be produced by patients.

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19. fn1 1 Further information on this doctoral research can be found in the unpublished dissertation available at the University of Otago library.
20. fn2 2 A previously “unmentioned mentionable” refers to something which a participant may wish to bring up in a conversation but has not had the chance to do so. The pre-closing allows interactional space for such talk to occur should a participant wish to bring it up ( Schegloff and Sacks, 1973).
21. fn3 3 A term coined by Schegloff to cover all types of talk, regardless of its character or setting (Schegloff, 2007).
22. fn4 4 Often the structures in conversation are referred to as “rules”, such as the “rules of turn-taking”. The word “rules”, however, is an unfortunate term to use as it implies that these are unbreakable and lends CA an air of prescriptivism. A more appropriate description of these findings may be “normative structures” as participants normatively orient to certain structures in conversation. However, I will continue to use the word “rules” when discussing previous research that has adopted this term, otherwise I will tend towards the more neutral term “normative structures” or simply “structures”.
23. fn5 5 A registrar is a doctor who has completed their postgraduate training years and has entered into specialisation training.
24. fn6 6 A terminal exchange sequence is where participants conclude a conversation with a sequence that signifies the termination of the interaction, usually with words such as “goodbye”, “bye” or “see you later”.
25. fn7 7 Epistemic advantage refers to the uneven distribution of knowledge that is common is institutional interactions. That is, surgeons have had more experience and therefore have more understanding and knowledge regarding the functions of the institution and its interactions than do patients.
26. fn8 8 Resistance here refers to interactional resistance in contrast to interactional alignment.

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Affiliations: 1: Macquarie University, Australia


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