Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
I fully support the feelings expressed by Judith Hendley . Although she did not expand on the bullet point, she was right to state that it is important out find out the ‘things that matter to patients’. Fear is a dominant human emotion. Physicians should not allow patients to live with fear that may be unwarranted, but if realistic fear does need to be addressed.
As a physician trying to help those with disabling spinal pain, I once asked a consecutive group of 86 new referrals what worried them about their pain?  Only 13 denied having specific fears and only a fifth worried about the cause of their pain. Most were concerned about future disability, e.g.being confined to a wheelchair, etc. Thus physicians concerned only with diagnosis and disease management may be offering reassurance where none is needed and missing the point where it is needed!
Whilst one tries hard to ascertain what does worry patients during one’s history taking, one does not always succeed until the final examination is concluded – when patients occasionally asked – is it cancer doctor?
(1) Hendley J. Are you well controlled? BMJ (Clinical research ed ) 2018; 363:k3119.
(2) Grogan E, Frank AO, Keat A. Patients in rheumatology clinics need reassurance. BMJ 2000; 321(29 July):300.
No competing interests
26 November 2018
Andrew O. Frank
Retired consultant physician in rehabilitation medicine and rheumatology
Northwick Park Hospital
Arthritis Centre, Northwick Park Hospital, Harrow, HA1 3UK