The literature on “small talk” has not described the way in which this talk, even as it “oils the social wheels of work talk” (Holmes 2000), enables disattending to the instrumental tasks in which one or both participants may be engaged. Small talk in simultaneity can disattend to the movements, bodily invasions, and recording activities functional for the instrumental tasks of medicine. Small talk in sequence occurs in sensitive sequential environments. Surgeons may use small talk to focus away from psychosocial or other concerns of patients that may focus off the central complaint or treatment recommendation related to that complaint. Patients may use small talk to disattend to physician recommendations regarding disfavored therapies (such as exercise). Overall, small talk often may be used to ignore, mask, or efface certain kinds of agonistic relations in which doctor and patient are otherwise engaged. We explore implications of this research for the conversation analytic literature on doctor–patient interaction and the broader sociolinguistic literature on small talk.