Primary care patients frequently present to their physicians with more than one medical concern. Data from the 1998 National Ambulatory Medical Care Survey (NAMCS) indicate that some 35% of patients present with two or more reasons for the medical visit and that this figure rises to 42% for patients presenting on an acute basis. These statistics suggest that physicians can face severe problems in managing their patients' arrays of concerns fully and effectively. In a context in which cost pressures are generally reducing visit times, physicians have less time to gather information about patients' health and relevant history taking may be abbreviated. Studies suggest that new and potentially severe medical problems may emerge late in visits, further curtailing the opportunity for physicians to address them in a complete and efficacious manner. The proposed study aims to investigate the extent of patients' unarticulated complaints and physicians' management of multiple complaints in the acute primary care context. The central study objective is to determine whether a simple communication intervention will assist patients in articulating multiple complaints and permit them to be addressed more fully and effectively. This research will use 220 videotaped records of physician-patient communication, together with pre- and post-visit patient surveys, in a quasi-experimental design that involves a simple manipulation of physician communication behavior. The study will also model a training intervention if the results are as hypothesized. The knowledge gained from this study will provide the basis for a training intervention which improves the quality of care for patients presenting with multiple concerns.
| Robinson, Jeffrey D; Tate, Alexandra; Heritage, John (2016) Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns? Patient Educ Couns 99:718-23 |
| Heritage, John; Robinson, Jeffrey D; Elliott, Marc N et al. (2007) Reducing patients'unmet concerns in primary care: the difference one word can make. J Gen Intern Med 22:1429-33 |
