ABSTRACT
This chapter highlights that the early moments of the consultation are crucial. Patients can be very unsure about what they will tell clinicians and, if they don't know them well, may be completely unable to anticipate how clinicians will respond to a difficult or sensitive matter. If the patient raises a small balloon, figuratively speaking, make sure health professionals don't inadvertently shoot it down. Clinicians in secondary care talk about the 'golden hour' – when dealing with a patient who has suffered severe trauma, for example in an accident. Many consultations have a prologue or overture which begins at the moment the patient becomes aware that clinicians are ready for them and realises that clinicians are calling them into their room, even if they are not present at that moment. It would help to watch and listen for the different ways that patients start consultations and rite these down at the end of each consultation.
