<![CDATA[Background: Patient silence in Indonesian medical consultations remains insufficiently examined, although formal patient rights, medical hierarchy, linguistic difficulty, family involvement, and digital consultation formats increasingly shape how voice is distributed in clinical encounters. Objective: This study examines how silence, deference, and unequal access to question-asking are institutionally framed and pragmatically mediated in Indonesian medical communication. Method: This study applies a qualitative corpus-based discourse-pragmatic design to 26 public document–excerpt units, classified as primary, secondary, and contextual data, using institutional voice allocation analysis, pragmatic silence coding, and interactional mediation mapping. Results: Formal rights discourse strongly recognises patients as entitled to information, explanation, complaint, consent/refusal, and second opinion, yet these rights are more often stated as institutional entitlements than translated into concrete interactional procedures. Silence and deference appear as communicative risks linked to power asymmetry, embarrassment, jargon, language barriers, and compliance-oriented positioning. Patient voice is frequently mediated through family members, legal complaint channels, telemedicine, documentation systems, and comprehension supports rather than expressed as direct individual questioning. Implication: This study suggests that non-questioning should not be interpreted as understanding, consent, or satisfaction without examining the interactional conditions that make speaking possible. Novelty: This study contributes a three-part analytical model that reframes patient silence as an institutionally distributed, pragmatically constrained, and relationally mediated form of unequal voice.]]>
