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The article presents a paper that explores ways in which general practitioners make sense of the changing political economy of this relationship. It explains that the interpersonal relationship between doctor and patient is fundamental to general medical practice. However, it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, ways are explored in which consultation is the site of negotiated power relations between doctor and patient, and is the site of the doctor's negotiation of powerful discourses of professional and institutional identity. It develops some ideas about the relationship between doctors and patients in general practice. It focuses on the ways in which the professional rhetoric of general practice has come to be organized around a very specific view of the possibilities that arise from this relationship.