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The main objective of this research is to investigate the epistemic and pragmatic management of patient-doctor interactions in Italian online health communities. To achieve this goal, an advanced web scraping methodology was used to extract from an Italian Q&A service (within the healthcare platforms, Il Mio Dottore) 200 pairs of questions and answers concerning two pathological conditions: anxiety and hypothyroidism. We first tagged the two sub-corpora and analyzed them both quantitatively and qualitatively to establish (i) what types of questions were used by patients, and what epistemic attitude and pragmatic function they convey; (ii) whether doctors' replies were aligned or not; (iii) whether there were differences between the two sub-corpora. The results revealed many similarities between the two sub-corpora, but also some differences, mainly concerning doctors' response patterns, with a tendency towards misalignment more pronounced in the anxiety sub-corpus. The practical implications of this and similar research may be numerous. First, they can improve understanding of the epistemic and pragmatic dynamics at play in Q&A services. Secondly, such knowledge can be used to formulate practical recommendations to foster better alignment with patients, thereby improving their engagement. Finally, this knowledge can guide the development of chatbot design guidelines., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)