Eliciting the Patient's Agenda- Analysis of Video Recorded Clinical Encounters

IntroductionEliciting the patient’s concerns and listening carefully to them is a key component of patient-centered care. Yet, clinicians often fail to elicit the patient’s agenda and, when they do so, they tend to... [ view full abstract ]

Introduction

Eliciting the patient’s concerns and listening carefully to them is a key component of patient-centered care. Yet, clinicians often fail to elicit the patient’s agenda and, when they do so, they tend to interrupt the patient’s discourse. Failure to identify the patient’s agenda may lead to over-testing and overtreatment as the true concern of the patient may be assumed or mischaracterized. We aimed to describe the extent to which patients’ concerns are elicited.

Methods 

A random sample of 112 clinical encounters video recorded during trials testing the efficacy of shared decision-making tools was analyzed. Two reviewers working independently and in duplicate characterized the elicitation of the patient agenda following a predefined framework.

Results

Clinicians elicited the patient agenda in 40 out of 112 (36%) encounters. This agenda was elicited more often in primary care (30/61 encounters, 49%) than in specialty care (10/41 encounters, 20%); p=0.058 The use of shared decision-making tools did not affect the likelihood of eliciting the patient agenda (34% vs. 37% in encounters with and without decision aids; p=0.09).  In 27 of the 40 (67%) encounters in which the patient concerns were elicited, the clinician interrupted the patient after a median of 11 seconds (interquartile range 7-22; range 3 to 234 seconds). Uninterrupted patients took a median of 6 seconds (interquartile rage 3-19; range 2 to 108 seconds) to state their concern.

Discussion

Clinicians seldom elicit the patient’s agenda; when they do so, they interrupt patients, at a rate that seems to have only quickened over time based on previous literature. Failure to fully elicit the patient’s agenda reduces the chance that clinicians will orient the clinical encounter to the specific and more important needs of each patient. Our findings suggest agenda setting is aborted repeatedly, highlighting a fixable opportunity to achieve right-size testing and treatment.