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Heisenberg in the waitng room
- Andrew J Ashworth (30 May 2006)
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Content of agenda forms
- Robert K McKinley, John F. Middleton , and Clare L. Gillies. (7 June 2006)
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Andrew J Ashworth, GP Davidsons Mains Medical Centre EH4 5BP
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In quantum mechanics, Heisenberg’s uncertainty principle states: “The simultaneous measurement of two conjugate variables (such as the momentum and position or the energy and time for a moving particle) entails a limitation on the precision (standard deviation) of each measurement. Namely: the more precise the measurement of position, the more imprecise the measurement of momentum, and vice versa. In the most extreme case, absolute precision of one variable would entail absolute imprecision regarding the other.” In other words it is impossible to measure a system without affecting that system due to a measurement effect on the system. Since the patient’s agenda and the General Practitioner’s view of that agenda are conjugate variables, it follows that measuring one (through an agenda form) will inevitably affect the other (perhaps, for example, shifting the patient’s view and description of their own agenda by completion of the form). In the study commented on about 5% of patients failed to complete agenda forms, though this may reflect illiteracy in the population studied, they might have served as a useful control for this measurement effect had the study design permitted this. Furthermore we are not informed of the measurement effect on GPs consultation time: did their behaviour change as a result of being in a study? Our waiting room is a hotbed of social interaction and our consulting rooms are private places where tears and laughter are often expressed: if patients don't get better at teh doctors, they at least have the opportunities to feel better. It would be a pity if unmeasured benefits were lost by another well-meaning form-filling exercise. Competing interests: I condsider my personality to affect my relationship with patients |
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Robert K McKinley, Senior Lecturer Department of Health Sciences, University of Leicester, LE5 4PW, John F. Middleton , and Clare L. Gillies.
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In response to our RCT of the effects of agenda forms on consultation outcomes,(1) Dr Hamilton and Professor Britten hypothesise that ‘Perhaps the main benefit from agenda forms is allowing embarrassing problems to be voiced’ and suggest that it would be useful to analyse the content of agenda patient forms.(2) We have completed and published an analysis of 749 agenda forms completed during our research.(3) The focus of this analysis was to increase our understanding of what patients wished to communicate rather than to examine the prevalence of ‘embarrassing problems’. The analysis demonstrated the complexity of the patients’ agenda (for example there was a mean of 4.9 separate items identified on each form) and what they wished to communicate in the consultation. Although this included difficult to communicate issues such as adverse comments on the care they had received, we cannot comment on the frequency of ‘embarrassing problems’ except to say that this did not emerge as an important theme. Agenda forms may enable patients to communicate embarrassing problems. It would be very useful to know whether they do. Reference List 1. Middleton, J. F., McKinley, R. K., and Gillies, C. L. Effect of patient completed agenda forms and doctors' education about the agenda on the outcome of consultations: randomised controlled trial. http://bmj.bmjjournals.com/cgi/rapidpdf/bmj.38841.444861.7C . 17-5-2006. 2. Hamilton W,.Britten N. Patient agendas in primary care. BMJ 2006;332:1225-6. 3. McKinley RK,.Middleton JF. What do patients want from doctors? Content analysis of written patient agendas for the consultation. Br.J.Gen.Pract. 1999;49:796-800. Competing interests: None declared |
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