Useful to know before a consultation

By Stethoscopes. licensed as CC BY-SA 3.0

What to expect from a consultation

A first consultation lasts roughly one hour. This time is necessary to establish a therapeutic relationship, explore in depth the patient’s problems, understand their ideas, concerns, and expectations, in order to consider as many things as possible in the differential diagnosis, and formulate a diagnostic and treatment path that is tailored to the patient. The famous British doctor William Osler’s words: “Listen to your patient! He is telling you the diagnosis” cannot be more true.

I will ask many questions -- on the issue that made you come for a consultation, on your medical history, on medicines and therapies you take, and where relevant, about your close family and those who live with you. I will ask questions about the state of your health throughout your life so far, with the purpose of building a timeline, a history of your health, and reconstruct the dynamics through which your issues (sometimes, initially seemingly unrelated) have presented. I will ask you questions that may seem distant from your problem: this step is however essential, to have a full and holistic view of the state of your health.


Whilst always explaining in advance what I propose to do and how it would be done (and making sure I have your prior consent to do so), I will undertake a full physical examination (excluding intimate examinations, which will only be undertaken if they are directly relevant to the main issue you came to consult me about), with particular emphasis on the symptoms of the issue that brought you to consult me.


During the consultation, I will take notes of what we say to each other on an encrypted computer, with the best possible cryptographic security. At the end ofthe consultation, I will write a brief summary of the main points of the consultation, as well as a summary of recommendations and next steps, as well as any prescriptions for medicines or diagnostic tests that we have agreed on. In the following days I will prepare an in-depth letter that I will make available for you to pick up, and/or be sent to you through a previously mutually agreed secure channel.

Some suggestions to get the most out of a consultation: 

Bring all the medical records you have with you, even those that may seem irrelevant to your current issue. Clinic letters, blood tests, and diagnostic imaging (if you have them, the images themselves are ideal) are all useful.

Bring a list with you of all medicines, supplements, herbal/natural/homeopathic medicines that you take, whether you take them regularly or on an “as needed” basis. This list should include:

Sometimes it may be useful to prepare a list of symptoms in advance, and a brief history of how your condition has evolved in the recent past, to make our conversation more fluid at first.

Many patients like to make notes of questions and doubts that they wish to share with me, so as to be sure to bring every issue they care about discussing to my attention, without risk of being derailed by the flow of conversation.