TY - JOUR T1 - The crowded consultation JF - British Journal of General Practice JO - Br J Gen Pract SP - 648 LP - 649 DO - 10.3399/bjgp12X659367 VL - 62 IS - 605 AU - Peter Davies Y1 - 2012/12/01 UR - http://bjgp.org/content/62/605/648.abstract N2 - Have you ever asked yourself just how many people are actually present in your consulting room? You should, as it is an interesting reflection. Let me show you why. For example you may think you are just dealing with a quiet afternoon appointment between you and Mrs Ackroyd, who is a 65-year-old lady who you know well and like. But actually, who else is also in the consulting room, either by invitation, or has muscled their way in by force, or inveigled their way in by implication? Let us have a look at this question.We will look at Mrs Ackroyd’s side of the consultation first. Why has she come today? Who or what has prompted her to come? Now this is a fairly standard MRCGP-type question and it can be answered with reference to her lay medical network and her health beliefs around her symptoms and their perceived level of severity and seriousness.Briefly in this case we know that she has significant relationships to her family; her husband who is at home digging the garden, her daughter who is a nurse, her neighbours, her friends and acquaintances, and that she is an avid reader of the newspaper medical column. She has had various past experiences of health and illness, and usually has had a good experience of the surgery, the doctor, and the staff. She is basically stoical, and can usually handle external information sensibly without either diminishing or exaggerating its accuracy and relevance to her own case.She may have either an obvious intrusive symptom such as pain, or an embarrassing problem that she has not mentioned for years and finally it has got bad enough for her to come and seek medical advice. At the start of the consultation she may still not be sure whether … ER -