Closing surgeon-patient consultations

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.