Closing medical encounters: two physician practices and their implicationsfor 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 b eginnings of encounters. A challenge to health care is how to get patients' additional concerns raised as topics of discussion. If patients' additiona l concerns are addressed, it tends to occur at the end of encounters. Using the methodology of conversation analysis. this article identifies and desc ribes the interactional organization of two physician-initiated communicati on practices that are used to negotiate the closure of the business of enco unters and a transition into the activity of closing encounters themselves. These practices have different implications for the topicalization of pati ents' additional concerns. (C) 2001 Elsevier Science Ltd. All rights reserv ed.