Closing medical encounters: two physician practices and their implications for the expression of patients’ unstated concerns

When patients visit primary-care physicians, they frequently have more than one concern. Patients’ first concerns are solicited by physicians at the beginnings of encounters. A challenge to health care is how to get patients’ additional concerns raised as topics of discussion. If patients’ additional concerns are addressed, it tends to occur at the end of encounters. Using the methodology of conversation analysis, this article identifies and describes the interactional organization of two physician-initiated communication practices that are used to negotiate the closure of the business of encounters and a transition into the activity of closing encounters themselves. These practices have different implications for the topicalization of patients’ additional concerns.