Key points

  • The report identifies the mutual fears that drive doctors and patients and the invisible structures that are natural to the doctor but hidden from the patient.
  • The report looks at five main ways of thinking differently about the current patient–clinician relationship, which might lead to different thinking about how to act:
    • making sense of ‘the consultation’
    • fear as a driver of the dynamic
    • invisible structures
    • fragmented conversations
    • system dynamics.
  • In order for patients to be better involved in making decisions about their own care, the consultation needs to change.
  • Commissioning bodies and service providers need to develop programmes that will boost patient skills and confidence and also support those doctors who are keen to experiment with new ways of working.

This report explores the main form of interaction between a patient and a clinician – the consultation. It uncovers the anxieties that both parties may feel, with doctors and patients each having their own concerns.

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