Soliciting the patient's agenda - Have we improved?

Context Previous research indicates physicians frequently choose a patient problem to explore before determining the patient's full spectrum of concer ns, Objective To examine the extent to which experienced family physicians in v arious practice settings elicit the agenda of concerns patients bring to th e 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 f amily counseling. Main Outcome Measures Patient-physician verbal interactions, including phys ician solicitations of patient concerns, rate of completion of patient resp onses, length of time for patient responses, and frequency of late-arising patient concerns. Results Physicians solicited patient concerns in 199 interviews (75.4%), Pa tients' 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 compl etion of concerns. Late-arising concerns were more common when physicians d id not solicit patient concerns during the interview (34.9% vs 14.9%), Fell owship-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 the ir concerns, Once redirected, the descriptions are rarely completed. Conseq uences of incomplete initial descriptions include late-arising concerns and missed opportunities to gather potentially important patient data. Solicit ing the patient's agenda takes little time and can improve interview effici ency and yield increased data.