“My patients come with too many problems,” is a common grievance I hear from doctors. Your patient wants your help with their shoulder pain, the diarrhea, a form and prescription refills, which doesn’t include your priorities which are checking the blood pressure and discussing the elevated A1C. Too many topics to cover fruitfully in the short appointment time that was booked, and maybe you’re also running 10 minutes behind at this point.
This is not an issue of too many problems, rather about agenda-setting.
When we frame the clinical encounter as the doctor’s job to solve patient problems, the dynamic is problematic. It suggests we have the best answers when in most cases we don’t. It also reinforces the power dynamic that elevates physicians and disempowers patients which is unhelpful to all patients, particularly those from marginalized groups who already experience more significant barriers to accessing care.
I recommend shifting the dynamic to doctor and patient sitting beside one another looking at solving the problem together.
We want to hear about all our patients’ issues so we can co-create an agenda for their visit and plan for future appointments to other issues. “Tell me all the things on your list,” and then “anything else?
Next, prioritize the list together. This only takes about 30 seconds, but it’s well invested. You might have some priorities based on critical labs or investigations, or you may be able to organize some of your patient’s discrete issues onto a group if you see the potential for them to have a related cause.
I find my patients understand we can’t talk about everything, even in the very generous 30-minute appointments I have. We agree at the beginning of the appointment which issues will be covered and which deferred and they are reassured when I tell them at the end that we will discuss them at the next scheduled appointment. And I keep my word.
Setting the agenda at the beginning is also insurance against ‘door knob issues. In most cases it can be tacked onto the agenda for the next appointment. And patients get used to it so they come to expect it.
Bottom line: set an agenda, every time.
[ Photo credit: Glenn Carstens-Peters on Unsplash]
