Cookies Policy

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies.

I accept this policy

Find out more here

Full Access Closing Surgeon-Patient Consultations

No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.
MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Closing Surgeon-Patient Consultations

Full text article:

  • XML
  • PDF
  • HTML
Add to Favorites

image of International Review of Pragmatics

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.

1. ARCH website. 2010. Downloadable at
2. Clayman Steven E. ,and Teas Gill Virginia. , 2004. "Conversation analysis". In Byman A. ,and Hardy M. (eds.), Handbook of Data Analysis , 589- 606. Beverly Hills, CA: Sage.
3. Gardner Rod. 2001. When Listeners Talk: Response Tokens and Listener Stance . Amsterdam: John Benjamins.
4. Heritage John. 1984. Garfinkel and Ethnomethodology . Cambridge: Polity Press.
5. Heritage John. , 2004. "Conversation analysis and institutional talk: analyzing data". In Silverman David (ed.), Qualitative Research: Theory, Method, and Practice , Second Edition, 222- 245. London: Sage.
6. Heritage John ,and Clayman Steven. 2010. Talk in Action: Interactions, Identities, and Institutions . West Sussex: Wiley-Blackwell.
7. Heritage John ,and Maynard Douglas (eds.). 2006. Communication in Medical Care: Interaction between Primary Care Physicians and Patients . Cambridge: Cambridge University Press.
8. Heritage John ,, Robinson Jeffrey ,, Elliot Marc ,, Beckett Megan ,and Wilkes Michael. 2007. "Reducing patients’ unmet concerns in primary care: the difference one word can make". Journal of General Internal Medicine Vol 22: 1429- 1433.
9. Hudak, Pamela, Shannon Clark and Geoffrey Raymond. 2009. In the shadow of surgery: treatment recommendations and the institutionality of orthopaedic surgery. Paper presented at the 2nd International Meeting on Conversation Analysis and Clinical Encounters.
10. Jefferson, Gail. 1984. "On stepwise transition from talk about a trouble to inappropriately next-positioned matters"In Atkinson J. ,and Heritage J. (eds.), Structures of Social Action: Studies in Conversation Analysis , 191- 222. Cambridge: Cambridge University Press.
11. Peräkylä Anssi. 1998. "Authority and accountability: the delivery of diagnosis in primary health care". Social Psychology Quarterly Vol 61: 301- 320.
12. Robinson Jeffrey D. 2001. "Closing medical encounters: two physician practices and their implications for the expression of patients’ unstated concerns". Social Science and Medicine Vol 53: 639- 656.
13. Schegloff Emanuel A. 2007. Sequence Organization in Interaction ( Vol Vol. 1). Cambridge: Cambridge University Press.
14. Schegloff Emanuel A. ,and Sacks Harvey. 1973. "Opening up closings". Semiotica Vol 7: 289- 327.
15. ten Have Paul. 1999. Doing Conversation Analysis . London: Sage.
16. West Candace. , 2006. "Coordinating closings in primary care visits: producing continuity of care". In Heritage John ,and Maynard Douglas W. (eds.), Communication in Medical Care: Interaction between Primary Care Physicians and Patients : 379- 415. Cambridge: Cambridge University Press.
17. White Jocelyn ,, Levinson Wendy ,and Roter Debra. 1994. "“Oh, by the way…”: the closing moments of the medical visit". Journal of General Internal Medicine Vol 9: 24- 28.
18. White Jocelyn ,, Rosson Connie ,, Christensen John ,, Hart Rosemary ,and Levinson Wendy. 1997. "Wrapping things up: a qualitative analysis of the closing moments of the medical visit". Patient Education and Counseling Vol 30: 155- 165.
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.

Article metrics loading...


Affiliations: 1: Macquarie University, Australia


Can't access your account?
  • Tools

  • Add to Favorites
  • Printable version
  • Email this page
  • Subscribe to email alerts
  • Get permissions
  • Recommend to your library

    You must fill out fields marked with: *

    Librarian details
    Your details
    Why are you recommending this title?
    Select reason:
    International Review of Pragmatics — Recommend this title to your library

    Thank you

    Your recommendation has been sent to your librarian.

  • Export citations
  • Key

  • Full access
  • Open Access
  • Partial/No accessInformation