Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2000 May 6;320(7244):1246-50.
doi: 10.1136/bmj.320.7244.1246.

Patients' unvoiced agendas in general practice consultations: qualitative study

C A Barry  1 , C P Bradley, N Britten, F A Stevenson, N Barber
Affiliations

Patients' unvoiced agendas in general practice consultations: qualitative study

C A Barry et al. BMJ. .

Erratum in

  • BMJ 2000 Jul 1;321(7252):44

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.

PubMed Disclaimer

Comment in

References

    1. Frankel R, Beckman H. Evaluating the patient's primary problems. In: Stewart M, Roter D, editors. Communicating with medical patients. 1989.
    1. Henbest RJ, Stewart M. Patient-centredness in the consultation, 1: method for measurement. Fam Pract. 1989;6:249–254. - PubMed
    1. Bradley CP. Uncomfortable prescribing decisions: a critical incident study. BMJ. 1992;304:294–296. - PMC - PubMed
    1. Stimson G, Webb B. Going to see the doctor. The consultation process in general practice. London: Routledge Paul; 1975.
    1. Levenstein JH, MeCracken EC, McWhinney IR, Stewart M, Brown JB. The patient-centred clinical method, 1: a model for the doctor-patient interaction in family medicine. Fam Pract. 1986;3:24–30. - PubMed

Publication types