Patients' unvoiced agendas in general practice consultations: qualitative study

Abstract

Objective To investigate patients' agendas before consultation and to assess which aspects of agendas are voiced in the consultation and the effects of unvoiced agendas on outcomes. Design Qualitative study. Setting 20 general practices in south east England and the West Midlands. Participants 35 patients consulting 20 general practitioners in appointment and emergency surgeries. Results Patients' agendas are complex and multifarious. Only four of 35 patients voiced all their agendas in consultation. Agenda items most commonly voiced were symptoms and requests for diagnoses and prescriptions. The most common unvoiced agenda items were: worries about possible diagnosis and what the future holds; patients' ideas about what is wrong; side effects; not wanting a prescription; and information relating to social context. Agenda items that were not raised in the consultation often led to specific problem outcomes (for example, major misunderstandings), unwanted prescriptions, non-use of prescriptions, and non-adherence to treatment. In all of the 14 consultations with problem outcomes at least one of the problems was related to an unvoiced agenda item. Conclusion Patients have many needs and when these are not voiced they can not be addressed. Some of the poor outcomes in the case studies were related to unvoiced agenda items. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agendas.

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

“…This suggests the potential for mismatch between GP and patient consultation agendas, which may act as an important obstacle to therapeutic alliance. Consultation agendas frequently go unspoken, leading to misunderstandings and frustration 25 . Previous studies have found similar differences in patients' and doctors' goals, with patients primarily seeking support, whilst physicians primary goal is symptom alleviation.…”

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients

“…Probably, this is also the case in selflimiting illnesses; mutual misunderstanding and ignorance or disagreement about views on health and illness may negatively influence patient-doctor relationship, patient compliance regarding advice and treatment, and patient satisfaction [21,31,32]. Therefore, exploration of these dimensions of patient's views is needed for optimal patient education and treatment of patients with self-limiting illnesses as respiratory tract symptoms as well as chronic diseases.…”

Untitled

“…Studies have shown that GPs rarely make patients' agendas (including their expectations) explicit in the consultation 4 and that they probably overestimate the patient's expectations of a prescription. 5,6 Exploring the patient's expectations and beliefs is therefore key to ensuring that prescribing is necessary and likely to bring benefit.…”

“…During the consultation, patients should be asked questions on their views and beliefs about their illness and treatment, and these must be explored fully before a decision on treatment is reached jointly between the healthcare professional and the patient. 10,11 • After a medicine has been prescribed, patients should have access to ongoing support so that any problems or questions that may arise can be addressed. Healthcare professionals should use all opportunities to talk with patients about their treatment and resolve any practical difficulties; medicines should also be reviewed regularly -with patients.…”