Intended for healthcare professionals

General Practice

Patients' unvoiced agendas in general practice consultations: qualitative study

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1246

This article has a correction. Please see:

  1. Christine A Barry, research fellow (christine.barry{at},
  2. Colin P Bradley, professorb,
  3. Nicky Britten, director of concordance unita,
  4. Fiona A Stevenson, lecturer in concordancea,
  5. Nick Barber, professor3
  1. 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
  2. b Department of General Practice, University College, Cork, Republic of Ireland
  3. c School of Pharmacy, University of London, London WC1N 1AX
  1. Correspondence to: C A Barry, Centre for the Study of Health, Sickness, and Disablement, Department of Human Sciences, Brunel University, Uxbridge, Middlesex UB8 3PH
  • Accepted 23 February 2000


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


  • Funding The study on which this paper is based is funded by the Department of Health as part of the prescribing research initiative. The views expressed in this paper are those of the authors and not the Department of Health. FAS is supported by Sir Siegmund Warburg's voluntary settlement

  • Competing interests None declared

  • Accepted 23 February 2000
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