- NEW YORK - Overall, only 28 percent 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 percent, according to a report in the Jan. 20 issue
of The Journal of the American Medical Association.
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- "Physicians commonly redirect and
focus clinical interviews before giving patients the opportunity to complete
their statement of concerns," according to the report. 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.
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- 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, according to lead author Dr. M. Kim Marvel, clinical
psychologist and director of behavioral medicine at the Family Medicine
Center in Fort Collins, Colo., and colleagues.
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- The good news is that patients need only
slightly more than 23 seconds to state their problems. Most people have
two or three things they want to discuss with their doctor, and if given
the chance, raise those issues in an average of 32 seconds.
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- "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," Marvel
said in an interview with Reuters Health.
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- "I think 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," he said.
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- Marvel and colleagues analyzed 264 patient-physician
interviews from 29 family physicians practicing in rural Washington, semirural
Colorado, and urban areas of the US and Canada.
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- They found that 75 percent 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 percent of patients had late-arising
questions, compared with 15 percent of cases in which the doctor did ask
such questions.
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- "Based on our findings, it is not
more time consuming to clarify the patient's full agenda, in fact it will
probably save time by decreasing the 'doorknob' questions," said Marvel.
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- "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," Marvel said.
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- "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."
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