In the beginning of the consultation the participants move from the preliminaries to the business at hand, the reason for the patient's visit. Greetings are exchanged, identities checked, the patient establishes an appropriate spatial and physical orientation, and the doctor sorts out equipment and documentation, not infrequently reading the medical record cards. These preliminaries entail a variety of concerns: a constant shifting of attention in which the participants are more or less aware of each other's actions and activities; a fragmentation of involvement, and necessarily so. In contrast, movement into the business of the consultation establishes a mutual focus of involvement, a stretch of continuous activity that concerns both participants and requires their coordination and joint attention.

Looking at one another plays a significant part in the process of establishing a common focus of activity and involvement, not simply as a means of monitoring each other's concerns and behaviour, but actually in initiating action and activity.