Using ethnographic discourse analysis in an Emergency Department in Hong Kong, this study explored the features of doctor-patient interactions in a hospital setting. By audio-recording 10 patient journeys, from triage to disposition, we analyzed the complexity of turn-taking patterns in spoken interactions between patients and doctors, as well as the subsequent complexities in this communication process. In particular, we traced the flow of communication surrounding the patients’ medical conditions at different stages of their journeys (e.g., taking patient history, making diagnosis and translating medical information in a bilingual environment). Communication in this Emergency Department, as in all Emergency Departments in Hong Kong, involves repeated translation from spoken Cantonese interactions to the written English patient notes and vice versa. For this study, the ethnographic discourse analysis includes different layers of detailed language diagnoses of the observed interactions (e.g., turn-taking strategies, speech functions and exchange structures). In this analysis, we examined the strategies that doctors used to transfer medical knowledge to their patients and with other clinicians; this research illustrated how a series of contextual factors (e.g., time pressure, staff shortages) were linked with the quality of doctor–patient communication. To illuminate the path for future research, we developed a dual-goal communication framework focusing on both medical and interpersonal aspects of the doctor–patient relationship. We strongly recommend the application of this framework for training medical students, junior clinicians and clinicians in practice.