IDENTIFYING AND ADDRESSING PATIENT CONCERNS: AGENDA SETTING

It is possible to adequately address a chief complaint but not identify or meet the patient’s concerns.

Agenda setting is defined as that process of the medical encounter where the doctor and patient agree on the plan for the visit. If agenda setting is not done, it defaults to whatever the doctor thinks is needed, and sometimes patients feel their concerns were not addressed.

Interpersonal skills are often portrayed as something we do in addition to our normal duties. The implication is that it would add time demands. But a group of researchers reported that certain interpersonal skills actually saved time.(Mauksch Arch Intern Med 2008) Those skills included rapport building, empathy, and agenda setting.

How do we conduct agenda setting? Here are two scripted phrases:

“What concerns you the most?” (addresses the patient’s fears)

“How can I be of most help to you?” (addresses the patient’s goals)

Another way of asking the second question is “what is your goal for this visit?” or “what would you most like to see accomplished?”

When we ask those sorts of questions we are identifying the patient’s concerns and needs, and setting the course for a more effective patient encounter.

Take home points:

-Set the agenda for the visit collaboratively with the patient

-“What concerns you the most?”

-“What would you most like to see accomplished today?”

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