The doctor-patient consultation is a complex interaction between two experts: The doctor, an expert in medicine, and the patient, an expert in his or her illness. For this interaction to be successful, it is important that both parties trust each other and communicate on a similar wavelength. The first minute of the consultation provides vital information to the doctor and lays the foundation for the consultation that ensues. Missed cues and a (heinous crime! During early days as a GP trainee, I remember consulting with a 20-year-old who played tennis for a local club. He presented with shoulder pain that had come on over a few weeks. There was no history of an injury. Having just completed my placement in orthopaedics, I performed a fluent shoulder examination, elicited shoulder tip tenderness along with a positive Scarf test and concluded that the patient had an acromio-clavicular joint sprain. I trotted clown the corridor to discuss my findings with my trainer, who kindly agreed to see the patient. After listening to the short history, my trainer asked the young man, 'Is there anything that could have caused it?' The patient replied, 'As I explained to the doctor, I haven't had a drink for a week but it is still hurting.' Trainer: 'What do you mean?' Patient: 'Oh, it's probably nothing really, but I live with a couple of medical students who looked at my shoulder as well. One of them mentioned that pancreatitis can cause shoulder pain.'
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