The components of consultation.

What people really want to see is a magician/physician. The shaman will know, better than the patient, what has been wrong so there is no need to delve into the history. With a potion or an incantation, the sickness will melt away. Failing a magical solution there could be a very private word or many more into the private doctor’s ear since the doctor’s time is at the disposal of a patient’s capacity to pay for it. There do remain vestiges of a contract that was once truly private and confidential. Those vestiges are what the recent General Medical Council admonitions sought to guard, but without making clear how vestigial they are. In the idealized contract, a patient approaches a practitioner for advice or treatment in exchange for a fee. The fee will be met from private funds, and the practitioner assumes that the patient can afford it or will perhaps modify it according to ability to pay. No one else is a party to this transaction; advice and privacy are bought together. No record is required beyond a word or two of aide-memoire in the doctor’s notebook. The therapeutic elements in the contract are the technical knowledge and resources immediately available to the physician and the powerful, personal, investment by the patient in the worth of the consultation. Both the technological and the psychological—placebo if you like—effects are conjoined. Few people can afford to pay for such medical services, for serious conditions, out of their current funds. Since doctors might decide not to charge everybody, or might scale their charges to individual means, they could also be seen to be munificent. Such is the historical basis of a medical consultation that is still, somehow, a fantasized basis for all doctor–patient encounters. On the debit side, total privacy allowed the possibility of unsupervisable medical practice. The regulations of the profession were put in place, in part, as a guard against the exploitation of the privacy. On the other hand, it could be the physician who is exploited, spun a tissue of lies, and there is not much in place to defend against that. The new-age shaman is the hypertechnician with a heart of gold, right up to date, micron accurate, evidence-based—as sharp as a magician and as likely to be found.