Pragmatic balance theory argues that rational communicators would make adequate pragmatic effort to accommodate their communicative needs for the sake of maintaining equilibrium of the interaction. Based on the theory and its four key concepts, communicative needs, pragmatic effort, pragmatic force and pragmatic effect, the present study, drawn data from naturally-occurring medical consultancy conversations, attempts to verify the pragmatic balance assumption in terms of the move, exchange and overall structure. It also finds that in terms of the overall structure, different distribution of medical consultants’ pragmatic identities and their discourse voice permeation reflect pragmatic balance in a macro-level, thus facilitating the opportunities of realizing speakers’ communicative needs. The study further claims pragmatic balance competence may be taken as an important part of pragmatic competence.