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The Yin and Yang of medical consultations
  1. John Launer
  1. Associate Editor, Postgraduate Medical Journal, London, UK
  1. Correspondence to Dr John Launer, Postgraduate Medical Journal, London WC1H 9JP, UK; johnlauner{at}

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I ran a seminar last week on listening to patients’ narratives and asked the doctors present if they ever saw patients who talked about their symptoms. It seemed such an absurd question that they all looked alarmed—except for one or two who gave me the indulgent look you receive when people think you are showing signs of cognitive decline. So I repeated my question in a slightly different way. How many of their patients, I asked, ever came into a consultation and say ‘My symptoms are…’ or indeed used the word ‘symptoms’ at all? We were then able to have an intelligent discussion about the words that doctors prefer to use and the ones that patients do, along with the different ways that doctors and patients conceptualise the world.

The fact is, patients very rarely come to doctors talking of ‘symptoms’, apart from a very few who prefer to use that kind of formal language. Instead, they use their own individual words, phrases and stories. They also grimace, make other facial expressions, point to parts of themselves and speak with their bodies, showing us physically, as well as verbally, what they are experiencing. We listen and watch—or believe we do—and then we sift these narratives through our medically trained minds and reformulate …

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