When it comes to a doctor's visit, the patient has an average of 23 seconds to state their concerns before a physician interrupts. Overall, only 28% of doctors know their patient's full spectrum of concerns before they begin to focus on one particular concern, and once the conversation is focused, the likelihood of returning to other concerns is only 8%. Physicians commonly redirect and focus clinical interviews before giving patients the opportunity to complete their statement of concerns. The problem is that the conversation rarely veers back to other concerns the patient might have, often leaving patients with the feeling they may not have discussed all their problems or even the most important one.
If the physician doesn't actively ask if all the points have been covered, patients tend to have more "doorknob" questions -- that is, they bring up an important problem just as they are leaving the office. The good news is that patients need only slightly more than 23 seconds to state their problems. Most people have 2 to 3 things they want to discuss with their doctor, and if given the chance, raise those issues in an average of 32 seconds. Our findings show that if those concerns are clarified at the beginning, you are less likely to have late-arising concerns, therefore the visits are more efficient and on average, the agenda setting portion of the interview takes about half a minute.
The best thing (for patients to do) is to prepare before the office visit, write down their concerns, so that when they get in to see the doctor they are able to verbalize very clearly and at the beginning what their concerns are. The researchers found that 75% of physicians elicited patient concerns, that is, they asked questions such as "How can I help you?" or "What brings you here today?" When a physician did not ask such questions, 35% of patients had late-arising questions, compared with 15% of cases in which the doctor did ask such questions. It's infrequent that the doctor asks if there are other concerns before they -- in my opinion -- prematurely start to delve into the first concern stated. So by keeping the agenda open a little longer and saying what else do we need to address today, it allows the doctor and the patients to plan the office visit to be more efficient and effective.
The Journal of the American Medical Association January 20, 1999;281:283-287.
COMMENT: This newsletter is unusual in that nearly one third of the readers are physicians. I believe that this is a valuable piece of research for both patients and physicians alike. I know that it really helped reinforce the importance of setting the agenda at the beginning of the visit. I am grateful to the authors for providing insights to improve patient visits.