Effectiveness of Intensive Physician Training in Upfront Agenda Setting

Brock, Dan W.; Mauksch, Larry B.; Witteborn, Saskia; Hummel, J; Nagasawa, Pamela R.; Robins, Lynne

doi:10.1007/s11606-011-1773-y

Cited by 42 publications

(41 citation statements)

References 31 publications

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“…Multiple studies have shown that communication skills can be improved with effective training, and that effective communication improves medical outcomes, safety, patient adherence, patient satisfaction, and provider satisfaction and efficiency. [5][6][7][8][9][10][11][12][13][14] Organization-wide communication skills improvement programs are rare and reports are limited to case studies. 15 We designed and implemented an experiential, relationship-centered communication skills course and measured its impact on patient satisfaction, physician empathy, burnout, and self-efficacy in a large, multispecialty academic medical center.…”

Section: Introductionmentioning

confidence: 99%

Communication Skills Training for Physicians Improves Patient Satisfaction

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Communication Skills Training for Physicians Improves Patient Satisfaction

et al. 2016

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“…But, as indicated above, this strategy typically generates single concerns, and is not effective in soliciting additional concerns beyond the chief complaint. Thus, a second strategy, and the focus of this article, involves physicians continuing to solicit patients' concerns 'to exhaustion' [5,8,[20][21][22], for example with questions such as "Are there any other issues you'd like to address"? This type of agenda pursuit has its greatest effects when performed 'early' or 'up front' during visits (i.e., no later than history taking, and preferably immediately after patients' presentations of their chief concerns) [15,21].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, a second strategy, and the focus of this article, involves physicians continuing to solicit patients' concerns 'to exhaustion' [5,8,[20][21][22], for example with questions such as "Are there any other issues you'd like to address"? This type of agenda pursuit has its greatest effects when performed 'early' or 'up front' during visits (i.e., no later than history taking, and preferably immediately after patients' presentations of their chief concerns) [15,21]. As a component of patient-centered communication [15,[23][24][25], and ultimately of shared decision making [26], agenda pursuit is now a staple of textbooks on medical interviewing [27][28][29] and is a frequent component of physiciantraining programs [5,18,22,[30][31][32][33][34][35].…”

Section: Introductionmentioning

confidence: 99%

“…As a component of patient-centered communication [15,[23][24][25], and ultimately of shared decision making [26], agenda pursuit is now a staple of textbooks on medical interviewing [27][28][29] and is a frequent component of physiciantraining programs [5,18,22,[30][31][32][33][34][35]. It has also been integral to innovations in medical interviewing, such as the 'four-habits model' [26,36] and the 'establishing-focus protocol' [16,21,37]. In addition to reducing the incidence of unmet concerns [2], up-front agenda pursuit is associated with patient satisfaction [14], improved physician understanding of patients' concerns [12], and a decreased incidence of late-emerging concerns [8,38].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to reducing the incidence of unmet concerns [2], up-front agenda pursuit is associated with patient satisfaction [14], improved physician understanding of patients' concerns [12], and a decreased incidence of late-emerging concerns [8,38]. Upfront agenda pursuit does not appear to significantly affect visit length [2,8,21], perhaps because it facilitates effective time management [39,40].…”

Section: Introductionmentioning

confidence: 99%

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Agenda-setting revisited: When and how do primary-care physicians solicit patients’ additional concerns?

Robinson

Tate

2016

Patient Education and Counseling

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Objective: Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. Methods: We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses. Results: Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p < .001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., "Do you have any questions?"), those that were formatted so as to allow for 'concerns' (e.g., "Any other concerns?") were significantly more likely to generate some type of agenda item (Chi 2 (1, N = 131) = 11.96, p = .001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi 2 (1, N = 73) = 4.99, p = .025).Conclusions: Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions. Practice implications: Physicians should increase use of optimized forms of agenda setting.

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Questioning a Taboo

Mauksch

2017

JAMA

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published a study 1 reporting that physicians interrupt patients, on average, after 18 seconds during an encounter. According to Google Scholar, 2 this study has been referenced 1115 times in academic journals and books, 50 times alone in 2016. The mainstream press picked up on this study with titles such as "Study Finds Doctors Aren't Good Listeners" or "Prescription for Doctors: Listen More."In light of the 1984 finding, how many students, residents, and practicing physicians in the last 30 years have been told not to interrupt patients? This admonishment is well intentioned. Most people associate interruption with rudeness, often leading to patient complaints. Skillful listening is essential to accomplish critical health care functions such as identifying the reasons patients request care, making accurate diagnoses, conveying empathy and support, exploring self-management challenges, and more. Yet there is a nagging question: Should physicians never interrupt their patients?Over the years I have asked scores of physicians and many psychotherapists, "Do you ever interrupt your patients?" I have received two answers: "Yes" and "Of course." Frequently the respondent laughs sheepishly as if to say, "I know I'm breaking a rule." What does the literature tell us about interruption in the medical encounter? Early research examining interruption of patients stressed physicians' tendency to assert and retain power in the relationship. Subsequent studies provide a broader, more nuanced view. Physicians and patients interrupt one another often, and patients interrupt at least as frequently as physicians. 3 Not all interruptions are intrusive, competitive, or power-claiming. 3 While some interruptions are classified as neutral, others build rapport, offer support, and express cooperation. 4 The frequency of interruption varies among visit phases. 5 The first phase combines rapport building and agenda setting. A middle phase focuses on diagnostic inquiry and hypothesis testing. The final phase is treatment planning. Physicians tend to interrupt in the earlier phases of the visit using questions to clarify symptoms or concerns. Later in the interview, patients may interrupt more often using statements more than questions. 3 Despite this research, writings and teachings claim that interrupting patients is taboo. Can some interruptions improve the quality of care and help the patient and physician make better use of time? I believe the answer is yes. Allow me to share a few examples from different situations when interruptions might improve health care efforts and decrease physician stress.

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Effectiveness of Intensive Physician Training in Upfront Agenda Setting

Cited by 42 publications

References 31 publications

Communication Skills Training for Physicians Improves Patient Satisfaction

Communication Skills Training for Physicians Improves Patient Satisfaction

Agenda-setting revisited: When and how do primary-care physicians solicit patients’ additional concerns?

Questioning a Taboo

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