This article examines interactions between callers to a health helpline and specialist nurses. Helpline call-takers must judge the appropriate moment to move from listening to the caller's problem to offering them the appropriate service. In a study of Parkinson's UK nurse call-takers, we find that the pivot is the point at which the caller reports the upshot of their trouble in terms of an impact on their daily life. Indeed, if the caller seems likely not to produce this upshot report, it is generated by the call-taker. Using the method of conversation analysis, we analyse how these upshot formulations are reached, and how the call-taker subsequently edits them to deliver a service that stays within their institutional guidelines. The findings contribute to sociological and clinical understandings about how health problems are framed and managed interactionally to reach a deliverable outcome for both participants in a helpline environment.