Patients' unvoiced agendas in general practice consultations: qualitative study

doi:10.1136/bmj.320.7244.1246

BMJ 2000;320:1246-1250 ( 6 May )

General Practice

Patients' unvoiced agendas in general practice consultations: qualitative study

Editorial by Charles

Christine A Barry, research fellow, ^a Colin P Bradley, professor, ^b Nicky Britten, director of concordance unit, ^a Fiona A Stevenson, lecturer in concordance, ^a Nick Barber, professor. ^c

^a Department of General Practice and Primary Care, Guy's, King's, and St Thomas's School of Medicine, King's College, London SE11 6SP, ^b Department of General Practice, University College, Cork, Republic of Ireland, ^c School of Pharmacy, University of London, London WC1N 1AX

Correspondence to: C A Barry, Centre for the Study of Health, Sickness, and Disablement, Department of Human Sciences, Brunel University, Uxbridge, Middlesex UB8 3PH christine.barry{at}brunel.ac.uk

Objective: To investigate patients' agendas before consultationand to assess which aspects of agendas are voiced in the consultationand the effects of unvoiced agendas onoutcomes.
Design: Qualitativestudy.
Setting: 20 general practices in south east Englandand the WestMidlands.
Participants: 35 patients consulting 20 general practitionersin appointment and emergencysurgeries.
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 fordiagnoses and prescriptions. The most common unvoiced agenda itemswere: worries about possible diagnosis and what the future holds;patients' ideas about what is wrong; side effects; not wantinga prescription; and information relating to social context. Agendaitems that were not raised in the consultation often led to specificproblem outcomes (for example, major misunderstandings), unwantedprescriptions, non-use of prescriptions, and non-adherence totreatment. In all of the 14 consultations with problem outcomesat least one of the problems was related to an unvoiced agendaitem.
Conclusion: Patients have many needs and when these arenot voiced they can not be addressed. Some of the poor outcomesin the case studies were related to unvoiced agenda items. Thissuggests that when patients and their needs are more fully articulatedin the consultation better health care may be effected. Stepsshould be taken in both daily clinical practice and research toencourage the voicing of patients'agendas.

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