Epistemic engine, deontic driver: Turn-taking as a deontic domain in medical consultations

Abstract

This article examines how epistemic and deontic orders are jointly organized in Persian outpatient secondary-care consultations. Using Conversation Analysis, it investigates diagnosis delivery, treatment recommendation, and patient-initiated candidate diagnoses to show how knowledge and authority are negotiated turn by turn. The analysis advances a theoretical refinement by demonstrating that turn-taking practices themselves function as a deontic domain, rather than a neutral system for allocating speakership. Practices such as self-selection after silence, mitigated proposals, anticipatory completions, and sequence-closing moves are shown to assert, suspend, or reconfigure participants’ rights to determine the next action. Patient initiatives—often framed as modulated questions or recollections—briefly redirect clinical trajectories, while physicians mobilize turn-taking resources to restore epistemic and deontic primacy. The findings contribute to medical communication research by providing fine-grained evidence from an under-studied linguistic context and by showing how epistemic and deontic orders are enacted through the temporal organization of talk.