The laundry list

A common gripe from doctors is the patient who arrives with a never-ending list of issues. 

“These patients have unrealistic expectations,” they complain. “We can’t possibly address them all in the short time we have.” We might think that generating and prioritizing the patient’s issue takes away from time assessing and treating the primary concern. 

It’s a common fear for those of us who like to be efficient, however the average outpatient has about 1.7 concerns. As I discussed in my previous post, research shows that the first concern is usually not the primary concern. 

Eliciting a list takes about 32 seconds and significantly reduces the frequency of ‘door knob’ issues which are more common when an exhaustive list is not elicited early on.

I learned early on in my career, this concern is completely backwards. We want to hear the laundry list of issues, because therein lies not only the primary issue but some of the pertinent diagnostic facts. Our patients aren’t necessarily going to know that their urinary frequency and back pain are related, but it will surely inform our differential.

Tell your patient you want only the issues without the details. 

Then you and your patient prioritize what will be discussed that appointment, and which of the other issues are potentially relevant. The other issue you save and book follow-up appointments for.