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.