Focusing on the multi-dimensionality of interactional settings, this study analyzes how the material world is a significant factor in the sequential co-production of the video-taped doctor—patient interactions. The analysis shows how a material artifact, the patient's file, is relevant in two ways: a) as a device which is employed in the sequential organization of the interaction. The patient's file is being used in the contexts of topic development and topic change. b) The file with its specific physical and symbolic features (...) is being co-produced and contested by both actors as a knowledge reservoir. Further inspection of the interactions in concert with theoretical reflections of the role of space and materiality suggests that interactions should be interpreted as happening in spatially arranged constellations of material objects and actors. In these both rigid and flexible constellations boundaries are established, access is distributed, and meaning is solidified. (shrink)