Closing surgeon-patient consultations

In primary care, the transition between the treatment recommendation and the closing of the consultation is a point at which patients can raise additional concerns either about the current diagnosis and proposed treatment or an altogether different health concern (Robinson, 2001) . In surgeon-patient consultations in New Zealand, a patient is often referred for a single problem within the realm of the surgeon’s expertise, rather than having self-referred with a possible multitude of problems. This alters the way in which surgeon-patient consultations close when compared to how they are closed in primary care consultations. Closings in surgeon-patient consultationsare influenced by the recommended treatment, including whether the patient is expected back for a follow-up visit or will be referred back to the referring doctor or on to another doctor. Conversation analysis has been successfully used in the analysis of primary care communication research (Heritage & Maynard, 2006) . I have used what is known about the “generic orders of organization” (Schegloff, 2007) of conversation to analyse the turn-taking, sequence organization and turn design of 35 video-recorded consultations (collected between 2004 and 2006). The data includes consultations from general surgery, vascular surgery, breast cancer surgery, and cardiothoracic surgery. Overall, this research explores patient agency in the little studied area of surgeon-patient communication. It also provides important basic information regarding the structure of surgeon-patient consultations, which can be used in the development of training models for surgeons, which are currently primary care based. Using conversation analysis, this paper examines the way in which the closings of surgeon-patient consultations are co-constructed by the participants. This research has identified a number of different pre-closings (Schegloff & Sacks, 1973) used by surgeons to move toward closing the consultation. These non-mutually exclusive pre-closings include arranging surgery, referring back, arranging diagnostic testing and organising a follow-up appointment, to name a few. This paper also examines the ways in which both participants can move away from closing-relevant activities and in particular the conversational tools used by patients to maintain agency within the closing moments of the surgeon-patient consultation.