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JAMA. 1999 Jan 20;281(3):283-7.

Soliciting the patient's agenda: have we improved?

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  • 1Fort Collins Family Medicine Residency Program, CO, USA. mkm@libra.pvh.org

Abstract

CONTEXT:

Previous research indicates physicians frequently choose a patient problem to explore before determining the patient's full spectrum of concerns.

OBJECTIVE:

To examine the extent to which experienced family physicians in various practice settings elicit the agenda of concerns patients bring to the office.

DESIGN:

A cross-sectional survey using linguistic analysis of a convenience sample of 264 patient-physician interviews.

SETTING AND PARTICIPANTS:

Primary care offices of 29 board-certified family physicians practicing in rural Washington (n = 1; 3%), semirural Colorado (n = 20; 69%), and urban settings in the United States and Canada (n = 8; 27%). Nine participants had fellowship training in communication skills and family counseling.

MAIN OUTCOME MEASURES:

Patient-physician verbal interactions, including physician solicitations of patient concerns, rate of completion of patient responses, length of time for patient responses, and frequency of late-arising patient concerns.

RESULTS:

Physicians solicited patient concerns in 199 interviews (75.4%). Patients' initial statements of concerns were completed in 74 interviews (28.0%). Physicians redirected the patient's opening statement after a mean of 23.1 seconds. Patients allowed to complete their statement of concerns used only 6 seconds more on average than those who were redirected before completion of concerns. Late-arising concerns were more common when physicians did not solicit patient concerns during the interview (34.9% vs 14.9%). Fellowship-trained physicians were more likely to solicit patient concerns and allow patients to complete their initial statement of concerns (44% vs 22%).

CONCLUSIONS:

Physicians often redirect patients' initial descriptions of their concerns. Once redirected, the descriptions are rarely completed. Consequences of incomplete initial descriptions include late-arising concerns and missed opportunities to gather potentially important patient data. Soliciting the patient's agenda takes little time and can improve interview efficiency and yield increased data.

Comment in

PMID:
9918487
[PubMed - indexed for MEDLINE]
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