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There are many different models of the medical consultation. Most doctors nowadays will have learned one or more of these at medical school, or later on in their speciality training. The models largely depend on the idea that every consultation has, or should have, a regular pattern involving certain standard sections, each of these lasting several minutes. They generally propose what one might call a “symphonic” structure to the consultation. They see conversations between doctors and patients as meetings that need some kind of pre-determined shape. They regard the doctor as the conductor of the symphony, if not the sole composer.
Thus, for example, one very influential model proposes that every consultation should consist of five parts: initiating the session, gathering information, examination, explanation and planning, and closing the session.1 Another popular authority on the consultation suggests that doctors should generally follow a routine of “connecting, summarising, handing over, safety netting and housekeeping”.2 Other leading teachers offer a variety of names for different parts of the consultation and some models are more ornate than others, but broadly speaking they all share two assumptions: the consultation needs to have a standard structure, and the doctor needs to be in control of it.
In some ways, all these consultation …
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