Table 2.

Two consultations with poor outcomes as a result of unvoiced agendas

Case detailsUnvoiced agenda itemRelated problem outcome
Doctor No 2, patient No 7Patient has underlying worry that menstrual problems might be recurrence of cancer (in remission)Doctor doesn't pick up on patient's worries about this problem being cancer related, so therefore cannot allay these fears
Friend and family think problems might be related to “the change” (patient is 40 years old)Doctor doesn't think she is in menopause yet so this possibility is not explored, even though patient makes oblique reference to mother's and sister's menopause. Patient is left not knowing whether she is experiencing menopausal symptoms
How does doctor know what tablets to give if he hasn't tested her blood for hormone imbalance?Doctor thinks she is happy about treatment but patient doesn't use prescription and asks her cancer specialist for second opinion. She doesn't trust doctor's diagnosis in absence of blood test
Confusion about whether prescription is hormone replacement therapy or hormone drugsPatient is left not trusting doctor and waits to ask her cancer specialist for advice. He advises against hormone treatment
Does not want hysterectomyDoctor thinks drugs have 50% chance of working and if not she will have to have surgery but doesn't tell her this
Doctor No 9, patient No 28Patient is worried about nose surgery (broken in fight leading to breathing problems) as friends say they have never been right since similar operations. Also worried about losing sense of smellPatient does not get information about either his nose or risks and benefits of surgery
Patient mentions cold but is not troubled by it; he is worried about long term breathing problemsDoctor thinks patient is there to get antibiotics for his cold and patient gets two unwanted prescriptions: antibiotics and linctus
Wants to know if antibiotics have side effects and whether he can drink with themIf doctor had warned him about side effects he wouldn't have used prescription for antibiotics. Patient doesn't finish course of antibiotics when he gets side effects