The consultation was first broken down into phases in work done in Manchester, where nearly 2000 audiotaped consultations were analysed (Byrne and Long, 1976). Six phases were defined which appeared frequently to follow each other in sequence, but the emphasis was still very much on the doctor .

Next the consultation was viewed from the angle of maximizing the potential of each consultation, and not just dealing with the presenting problem and getting the patient out through the door (Stott and Davis, 1979). This important work described how other key elements of care, such as the management of continuing problems and opportunistic health promotion, could be raised when appropriate. However, it did not help doctors to understand where they were in the progress through a consultation.

1. The doctor establishes a relationship with the patient.

2. The doctor either attempts to discover or actually discovers the reason for the patient’s attendance.

3. The doctor conducts a verbal or a physical examination or both.

4. The doctor, or the doctor and the patient, or the patient (in that order of probability) consider the condition.

5. The doctor, and occasionally the patient, details treatment or further investigation.

6. The consultation is terminated, usually by the doctor.

The Byrne and Long consultation model (1976).

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