A pragmatic agenda for clinical communication must derive sound practice recommendations based on investigations of actual clinical practice rather than idealized practice. While it is reasonable to recommend that clinicians foster the inclusion and active participation of their patients, if such recommendations are based on top-down ideals rather than a sound, bottom-up empirical base, they are vulnerable to implementation challenges. This chapter introduces microanalysis of clinical interaction (MCI), which uses videorecorded consultations between clinicians and patients to reveal authentic communicative practice in interaction. We will briefly describe its history, unique features and affordances, and examples from studies that have applied it. We then focus on its potential utility for explicating how to accomplish patients’ inclusion and active participation in interaction.