Doctors and clients sometimes experience interactive clashes during hospital meetings in South-western Nigerian hospitals because of their divergent culture-constrained orientation to politeness cues. The goal of this paper is to unpack the discursive elements that characterize interactive confluence and divergence in selected consultative encounters in the hospitals. The findings indicate that institutional and cultural (dis)alignments occur in respect of adjacency and non-adjacency pair greetings. In both greeting types, face support, threat and stasis are conjointly co-constituted by doctors and Yoruba clients within the affordances of the cultural, institutional and situational context of the Southwestern Nigerian hospital setting. Adjacency pair greetings attract mutual interpretings between the parties; interactive disalignments are differentially pragmatically accommodated by doctors and clients. In non-adjacency pair greeting, doctors’ threats are co-constituted as appropriate by both parties, the institutional power of doctor and shared Western cultural orientation playing significant roles.