Printed in Great Britain Intruders in the consultation

A confidential consultation is the essence of family practice. That confidentiality is currently under attack from a number of disruptive influences. Several of these are physical intruders: telephone calls, undergraduate and postgraduate students, video recorders, computers, guidelines, protocols and health promotion activities. The potential benefits of each of these is analysed to elucidate why they have been allowed into consultations. Their drawbacks in the light of current published evidence is presented. Conditions which make intrusions permissible are proposed and practical suggestions are made about how to minimise their impact. The essential unit of medical practice is the occa-sion when, in the intimacy of the consulting room or sick room a person who is ill or believes himself to be ill, seeks the advice of a doctor whom he trusts. This is a consultation and all else in the practice of medicine derives from it. Sir James Spence 1953&apos