PATIENT-CENTREDNESS is at the heart of medicine.1 It is a core value of our discipline, recognised as the best way of helping an individual promote, preserve and restore their integrity of health.2 Patient-centredness is about giving the patient's viewpoint much more status in our hierarchy of clin-ical inputs;3,4 a revolution in the discussion of prognosis with dying patients was an early sign of this approach.5 Although the method has been endorsed in the rhetoric and vocational training of general practice for more than two decades, progress is slow and appears not yet to be widely realised in day-to-day consulting, even in specially selected consultations.6 Yet poor responsiveness to patients' wants can too often lead to mis-direction and waste of professional time and effort. Being responsive may often mean acknowledging and understanding the patient's wants rather than directly complying with them.7
The challenge is to consult both better and more efficiently. Attempts to relate consultation process to patient outcomes, such as satisfaction and enablement, have been rather unrewarding so far.8 This may mean that no one process suits even a significant proportion of patients. More research is needed here and several …