Small talk as work talk: Enacting the patient-centered approach in nurse-practitioner-patient visits


  • Staci Defibaugh Old Dominion University



closings, goal-oriented talk, medical visits, nurse practitioner, rapport enhancement, small talk


Small talk in medical visits has received ample attention; however, small talk that occurs at the close of a medical visit has not been explored. Small talk, with its focus on relational work, is an important aspect of medical care, particularly so considering the current focus in the US on the patient-centered approach and the desire to construct positive provider– patient relationships, which have been shown to contribute to higher patient satisfaction and better health outcomes. Therefore, even small talk that is unrelated to the transactional aspect of the medical visit in fact serves an important function. In this article, I analyze small talk exchanges between nurse practitioners (NPs) and their patients which occur after the transactional work of the visit is completed. I focus on two exchanges which highlight different interactional goals. I argue that these examples illustrate a willingness on the part of all participants to extend the visit solely for the purpose of constructing positive provider–patient relationships. Furthermore, because exchanges occur after the ‘work’ of the visit has been completed, they have the potential to construct positive relationships that extend beyond the individual visit.

Author Biography

  • Staci Defibaugh, Old Dominion University
    Staci Defibaugh is an Assistant Professor of Applied Linguistics at Old Dominion University. She received her PhD from the University of Illinois in 2015. Her research focuses primarily on identity construction in medical visits between Nurse Practitioners and patients, examining how aspects of the provider and patient identities are constructed through talk. She is also interested in the wider discourse surrounding Nurse Practitioners as a growing presence in the US.


American Association of Nurse Practitioners. (2017) More than 234,000 licensed nurse practitioners in the United States. Retrieved from

American Board of Medical Specialties. (2017) ‘Standards for initial certification’. Retrieved from:

Button, G. (1991) Conversation-in-a-series. In D. Boden and D. H. Zimmerman (eds) Talk and Social Structure, 251–277. Berkeley: University of California Press.

Ciechanowski, P. S., Katon, W. J., Russo, J. E. and Walker, E. A. (2001) The patient-provider relationship: attachment theory and adherence to treatment in diabetes. American Journal of Psychiatry 158 (1): 29–35.

Coupland, J., Robinson, J. and Coupland, N. (1994) Frame negotiation in doctor-elderly patient consultations. Discourse and Communication 5 (1): 89–124.

Cunningham, R. S. (2004). Advanced nursing practice outcomes: A review of selected empirical literature. Oncology Nursing Forum 31 (2): 219–230.

Drass, K. A. (1988) Discourse and occupational perspective: A comparison of nurse practitioners and physician assistants. Discourse Processes 11 (2): 163–191.

DuBois, J. (2007) The stance triangle. In R. Englebretson (ed.) Stancetaking in Discourse, 139–182. Amsterdam: John Benjamins.

Duggan, A. P. and Thompson, T. L. (2011) Provider-patient interaction and related outcomes. In T. L. Thompson, R. Parrott and J. Nussbaum (eds) The Routledge Handbook of Health Communication (second edition), 414–427. London and New York: Routledge.

Farup, P., Blix, I., Forre, S., Johnsen, G., Lange, O., Johannessen, R. and Peterson, H. (2011) What causes treatment failure – The patient, primary care, secondary care or inadequate interaction in the health services? British Medical Journal Health Services Research 11: 1–6.

Fisher, J. A. (2007) Coming soon to a physician near you: Medical neoliberalism and pharmaceutical clinical trials. Harvard Health Policy Review 8 (1): 61–70.

Holmes, J. (2000) Doing collegiality and keeping control at work: Small talk in government departments. In J. Coupland (ed.) Small Talk, 27–31. London: Pearson.

Hudak, P. and Maynard, P. (2011) An interactional approach to conceptualizing small talk in medical interactions. Sociology of Health & Illness 33 (4): 634–653.

Kliems, H. and Witt, C. M. (2011) The good doctor: A qualitative study of German homeopathic physicians. The Journal of Alternative and Complementary Medicine 17 (3): 265–270.

Maynard, D. and Hudak, P. (2008) Small talk, high stakes: Interactional disattentiveness in the context of prosocial doctor-patient interaction. Language in Society 37: 661–688.

National Organization of Nurse Practitioner Faculties. (2012) ‘Nurse practitioner core com­petencies’ (amended edition),

Oetzel, J., Wilcox, B., Avila, M., Hill, R, Archipoli, A. and Ginossar, T. (2015) Patient-provider inter­action, patient satisfaction, and health outcomes: Testing explanatory models for people living with HIV/AIDS. AIDS Care 27 (8): 972–978.

Ong, L. M. L., DeHaes, J. C. J. M., Hoos, A. M. and Lammes, F. B. (1995) Doctor-patient com­munication: A review of the literature. Social Science Medicine 40 (7): 903–918.

Palese, A., Tomietto, M., Suhonen, R., Efstathiou, G., Tsangari, H., Merkouris, A., Jarosova, J., Leino-Kilpi, H., Patiraki, E., Karlou, C., Balogh, Z. and Papastavrou, E. (2011) Surgical patient satisfaction as an outcome of nurses’ caring behaviors: A descriptive and correlational study in six European countries. Journal of Nursing Scholarship 43 (4): 341–350.

Ragan, S. L. (2000) Sociable talk in women’s health care contexts: Two forms of non-medical talk. In J. Coupland (ed.) Small Talk, 269–287. London: Pearson.

Robinson, J. H., Callister, L. C., Berry, J. A. and Dearing, K. A. (2008). Patient-centered care and adherence: Definitions and applications to improve outcomes. Journal of the American Academy of Nurse Practitioners 20 (12): 600–607.

Roter, D. and Hall, J. (2006) [1992] Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visit. Second edition. Westport, CT: Praeger.

Schegloff, E. A. and Sacks, H. (1973) Opening up closings. Semiotica 8 (4): 289–327.

Spencer-Oatey, H. (2002) Managing rapport in talk: Using rapport sensitive incidents to explore the motivational concerns underlying the manage­ment of relations. Journal of Pragmatics 34 (5): 529–545.

Spencer-Oatey, H. (2005) (Im)Politeness, face and perceptions of rapport: Unpackaging their bases and interrelationships. Journal of Politeness Research 1 (1): 95–119.

Stewart, M., Brown, J. B., Donner, D., McWhinney, I. R., Oates, J., Weston, W. W. and Jordan, J. (2000) The Impact of patient-centered care on outcomes. Journal of Family Practice 49 (9): 1–12.

Tracy, K. and Naughton, M. (2000) Institutional identity work: A better lens. In J. Coupland (ed.) Small Talk, 62–83. London: Pearson.

United States Department of Veteran Affairs. (2017) Veterans Health Administration. Retrieved from:

West, C. (2006) Coordinating care in primary care visits: Producing continuity of care. In J. Heritage and D. Maynard (eds) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, 379–415. Cambridge: Cambridge University Press.






How to Cite

Defibaugh, S. (2018). Small talk as work talk: Enacting the patient-centered approach in nurse-practitioner-patient visits. Communication and Medicine, 14(2), 97-107.