Family-Centered Agenda Setting
In a regular medical visit, most of the time is spent taking a history, conducting an exam, treatment planning, etc. However, if you as a healthcare provider will first take a moment to chart a conversational course (set an agenda) at the beginning of a visit, both you and patient may benefit. An agenda can make it easier for you to navigate the encounter, and can improve how well you meet your patients' needs. Even the specific words you use when agenda setting can make a difference. (1) Plus, agenda setting does not increase the length of visits and requires very little training or time to do. (2)
Agenda setting accomplishes a few things:
- It ensures that you're addressing the patient's concerns
- For example, a doctor might say,“Well, I see in your chart that you’ve come to see me about some headaches you've been having, so we’ll address that today. Is there something else you would like to discuss in the time we have together?”
- It focuses the visit so you can be more efficient and have control over the flow of your clinic time
- For example, suppose a doctor did not set an agenda. While wrapping up the visit she says to her patient, “Great. Well then I’ll see you back in 3 weeks…” As she reaches for the door the patient says, “Oh doc, I had one more question for you. I’ve got this pain in my back…” Already running behind, the frustrated doctor thinks to herself: Why didn’t you tell me this at the start? An agenda would have elicited the patient's back pain concern from the start.
- It makes redirecting a patient easier when on a conversational tangent
- For example, "Yeah that sounds like something we should discuss further at some point. For now let's get back to what we agreed we would focus on today, which is your headaches. When was the last time..."
- And finally, an agenda can help you prioritize
- Sometimes there is simply not enough time to address all the patient's health needs in one medical visit. While agenda setting you might say, “These are great things to discuss with me. We probably have time to address two or maybe three of them today. Which of your concerns is the most important to address first?"
When you set an agenda, be sure to include the patient's family members as well. They usually know more about the patient than you do. Sometimes they can help explain what the patient wants and needs even better than the patient can. Partner with family members from the very beginning by seeking their input into expectations and reasons for the visit.
The doctor in our previous video clip greeted his patient and introduced himself to his wife. Let's continue watching and now observe how he sets an agenda with both of them. As you watch please mark your observations on the FCOF. You'll be looking for only those skills listed in the "Agenda" section of the FCOF (highlighted in yellow below). Remember to add comments on the FCOF if you have any.
Need More Explanation?
The skills listed in this section are described below in more detail and with examples.
1. Note previous agenda items from either: (1) previous medical visits, or (2) the Electronic Health Record, or (3) other care team members (e.g. MA or nurse)
Start by orienting the patient and any family members to what you already know about the reason for their visit. You might say something like, “Last time you were here we agreed to focus on _____ today” or perhaps, “I see in your chart that you’re here today for a _______ follow-up”, or maybe, “My nurse told me you are hoping to __________.”
2. Solicit patient input on the agenda (e.g. “Is there something else…?”)
One of the best ways to be patient- and family-centered is to determine what they would like to address during the time you have together, but don’t just dive into the first thing they say. Rather, seek additional agenda items. Talk about what you're going to talk about before you talk about it. For example, a doctor might say to a patient, “My nurse told me you are traveling out of the country soon.” The patient replies, “Yeah and I’m wondering if we need any vaccines before we go.” Don’t ask yet where they are traveling to, how long they will be gone, or what vaccines they've already had. Rather, first respond with something like, “Ok. We will certainly discuss travel vaccinations today. Is there something else you’d like to discuss with me today?” Keep asking until you hear, “Nope. That’s all.” Then dive in.
3. Solicit input from the patient’s family member(s) (e.g. “Is there something you…?”)
In addition to asking the patient, ask any family members present to offer input on the agenda. Say something like, “Is there something you think we should address today?” Patients bring family members to their medical appointments for a variety of reasons (e.g. to offer emotional support, to help remember information, etc.). Invite their input because they may offer a unique and helpful perspective.
If the patient does not have family members present at the visit you can still seek their input. Simply ask, “What would your [family member] like me to address with you today?” You might hear something like, “My wife thinks I’m depressed, but I don’t know,” or maybe “My mom and dad think I should be on birth control even though I told them I’m not having sex.”
4. State your own goals for the visit
Patients know what they want, but they don’t always know what they need. Your input into the agenda is important because you may know what they need. For example, you might say, “So we’ll definitely talk about new birth control options today, but I also wanted to address your blood pressure. It’s a little high. In fact, it’s a lot high.”
5. Confirm or prioritize the agenda with the patient and family member(s)
Suppose a patient comes in with six different chronic problems that she hopes you’ll address in a 15-minute visit. You simply do not have time for all of them, so verbally prioritize her concerns with input from her and her family. For example, “These are great things to discuss with me. We may have time to address two or three of them today. Which of your concerns is the most important for us to deal with first?” Confirm the agenda with the patient and family, especially if it’s complex.
If the agenda only has one item then there is no need to prioritize, obviously, but you can still confirm it . You might say something like, “You're here today to talk about birth control options, correct?”
- Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: the difference one word can make. Journal of General Internal Medicine, 22(10), 1429-1433.
- Brock, D. M., Mauksch, L. B., Witteborn, S., Hummel, J., Nagasawa, P., & Robins, L. S. (2011). Effectiveness of intensive physician training in upfront agenda setting. Journal of general internal medicine, 26(11), 1317.