Doctor-patient communication is fundamental to the therapeutic relationship necessary to achieve mutual understanding of the implications and impact of illness, diagnostic and treatment decisions, and health outcomes. It is recognised that both patient and doctor come with their own perspectives, beliefs and agendas. This quasi-ethnographic study explores the influence of the doctor’s own a priori assumptions on their communication with a new patient. Methods Cognitive interviewing was used prior to consultations to explore the doctor’s thoughts triggered by the referral information. The relevant subsequent consultations were audio recorded, as were loosely structured interviews after the consultation, during which the doctor reflected on what had been said and why. All data was subjected to qualitative thematic analysis. Conclusion The source, content and format of referrals are significant and doctors approach the information about the patient with their own perspectives, beliefs and experiences. The existence of assumptions and stereotypes appear to be triggered when processing the information. Doctors begin to develop the communication with the patient, based on their expectations of themselves and of the patient, before the patient is seen. During the consultation, some a priori assumptions were observed to be significant. A priori assumptions are influential to the communication with the patient and can result in communication not anticipated by the clinician. The relationship achieved with the patient during the consultation can be understood in the context of the concepts of recognition and presence.