- William Hamilton, senior research fellow (firstname.lastname@example.org),
- Nicky Britten, professor
- Department of Community Based Medicine, University of Bristol, Bristol BS8 1AU
- Institute of Health and Social Care Research, Peninsula Medical School, Exeter EX1 2LU
People often have difficulty in fully expressing their concerns in consultations with doctors1 and this may adversely affect outcomes. Some issues go unvoiced or are introduced in a “by the way” presentation at the end of the consultation. The temporal order by which patients present their agendas may not reflect their perceived importance or match the doctor's prioritisation. The first item raised may be the most socially acceptable, and the last (or unvoiced) item—such as breast lumps or rectal bleeding—may be the vaguest or most embarrassing.
If they have time doctors may try to counter this by an open question, asking if there are any other problems.2 But doctors have to work within time constraints, and a few actively discourage the presentation of more than one problem per consultation. Examining the issue of patients' agendas—their ideas, concerns and expectations—brings out the tension between a patient-centred model of the consultation …