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
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