The neurological consultation usually has the following stages.

➤ Greeting: welcome the patient and introduce yourself.

➤ History:

➣ Opening – start by asking ‘Tell me about your symptoms’ rather than ‘Your doctor referred you because of . . . (e.g. headache), tell me about it’. The patient’s agenda may differ markedly from the referring doctor’s.

➣ Exploring – ask direct questions to explore the possible cause of the patient’s symptoms: ‘How often do you have headaches?’

➣ Generating a diagnosis or differential diagnosis – by the end of the history taking, you should have a clear idea of the possible explanation(s) for the patient’s symptoms.

➤ Examination: no neurologist does a full and detailed neurological examination on any one patient to begin with. The examination is usually focused and guided by diagnosis or differential diagnosis generated from the history. There is no point in doing a detailed sensory examination on a patient with a headache! Contrary to popular belief, neurological examination rarely 4provides a diagnosis; rather, it usually supports the history findings.

➤ Conclusions: formulate a plan that may include investigations. Explain the plan to the patient. Ask the patient if they would like to ask any questions.