Soliciting the Patient's Agenda: Have We Improved?

CONTEXT: Previous research indicates physicians frequently choose a problem to explore before determining the patient's full spectrum of. OBJECTIVE: To examine the extent to which experienced family in various practice settings elicit the agenda of concerns patients to the office. DESIGN: A cross-sectional survey using linguistic of a convenience sample of 264 patient-physician interviews. SETTING PARTICIPANTS: Primary care offices of 29 board-certified family physicians in rural Washington (n = 1; 3%), semirural Colorado (n = 20; 69%), urban settings in the United States and Canada (n = 8; 27%). Nine had fellowship training in communication skills and family. MAIN OUTCOME MEASURES: Patient-physician verbal interactions, physician solicitations of patient concerns, rate of completion of responses, length of time for patient responses, and frequency of-arising patient concerns. RESULTS: Physicians solicited patient concerns 199 interviews (75.4%). Patients' initial statements of concerns were in 74 interviews (28.0%). Physicians redirected the patient's statement after a mean of 23.1 seconds. Patients allowed to complete statement of concerns used only 6 seconds more on average than those who redirected before completion of concerns. Late-arising concerns were more when physicians did not solicit patient concerns during the interview(34.9% vs 14.9%). Fellowship-trained physicians were more likely to solicit concerns and allow patients to complete their initial statement of (44% vs 22%). CONCLUSIONS: Physicians often redirect patients' descriptions of their concerns. Once redirected, the descriptions are completed. Consequences of incomplete initial descriptions include-arising concerns and missed opportunities to gather potentially important data. Soliciting the patient's agenda takes little time and can interview efficiency and yield increased data.