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Although small talk has conventionally been treated as marginal and unimportant compared with core business talk, its value in understanding institutional norms and power relations has been recognized in many workplace contexts. However, in-depth analysis of the dynamics of small talk is still under-researched in clinical contexts. This paper explores where and how small talk is positioned, initiated, and closed between participants in two types of medical practices that co-exist in China: Traditional Chinese Medicine and Western Medicine. Analysis of 69 consultations suggests that small talk permeates into the boundaries of talk. The findings also demonstrate a marked clinical difference in relation to the distribution and discourse functions of small talk. [ABSTRACT FROM AUTHOR]