ABSTRACT
It is worth emphasising the simple but fundamental point that each consultation has a purpose. Each consultation should have a structure, which becomes routine. The consultation begins before the patient is seen, when the doctor reads the referral letter in the case of new patient or the last clinic letter in the case of follow-ups. The purpose of the consultations is to decide whether the operation has been successful in achieving its objectives. Examination in the out patient clinic can be difficult. The patient may be relatively immobile and encased in numerous layers of clothing, which take a long time to remove. A handwritten entry in the notes is necessary as a contemporaneous record of the consultation and the management plan. Good communication is at the heart of good medicine, and this is particularly the case in outpatient medicine.
