ABSTRACT
This chapter looks at communication between the practitioner and patient and how the presentation, past feelings, examination, and defences of both practitioner and patient all affect the consultation and bring the patient's unconscious feelings. The medical consultation with a patient, whether it takes place in general practice, a hospital clinic or a community clinic is usually fairly formulaic. The consultation should always be ‘free floating’; with the clinician observing what is happening, noting the thoughts and feelings in the room and allowing the patient to lead the discussion. The patient who makes phone calls to change the appointment several times before the visit is often hiding extreme anxiety about the consultation. Tears can be another very strong defence on the part of the patient. The patient will often have chosen the clinician by testing them out, with previous visits for different issues.
