Why this clinic now? A context-sensitive aspect of accounting for visits

In presenting problems in medical consultations, patients face the task of justifying their visit to the doctor. Previous studies have shown that patients establish the legitimacy of their visit by characterizing their problem as "doctorable" and presenting themselves as reasonable patients (Halkowski, 2006; Heritage and Robinson, 2006). This study explores a context-sensitive aspect of this justification issue by analyzing patients' first visits to a department of general medicine under the Japanese "free access" system. Patients are shown to present their problem in a way that conveys its relevance to the particular medical setting: they characterize their problem as suitable for relatively high-level medical care or as not easily falling under other specialties. The patient's problem's relevance to the setting is treated as normative in that participants take measures to remedy the possible mismatch between the problem and the setting. The institutional arrangement of the Japanese free access system is "talked into being" as a relevant context for the consultations through the practices participants use to establish the legitimacy of their visits.