Wrapping things up: a qualitative analysis of the closing moments of the medical visit.

The purpose of this preliminary study is to develop an operational definition of the closure phase of the medical visit. A listening group developed a definition of closure by consensus based on audiotaped data from 22 office visits to physicians. The group noted new problems in closure not previously raised. Closure was defined as the final phase of the medical visit in which the doctor and patient shift perspective to the future, finalize plans, and say goodbye. Two distinct organizational frameworks of closure are outlined. Thirty-six percent of closures were interrupted in some way. New problems occurred in 23% of visits, even those with open-ended beginnings and early physician requests for all patient concerns. Doctors' communication involved expression of emotion, patient education, clarification, summary, and parting comments. Patient communication included expression of emotion, information sharing, and parting comments. Doctors' communication skills for closure are proposed. Closure is a distinctive phase of the visit with an organizational framework and specific tasks. The frequency of new problems in closure suggests that physicians may have the potential to improve their effectiveness.