Agenda setting for consultations

Tags: Consultation skills 

Agenda setting is a communication skill that clinicians use at the beginning of a clinical visit to elicit, propose, and organize a complete list of topics to be covered. Topics are clinical issues raised by either patient or clinician. Agenda setting is thought to improve patient outcomes and experience, physicians' understanding of patients' concerns, and physician organization and time management by reducing the number of unaddressed concerns and, by extension, the number of “surprise” topics patients introduce later in the visit.

Examples of agenda setting in general practice:

• Clinician: "Good morning, Mrs. Smith. How can I help you today?"

• Patient: "I'm here for my annual checkup, and I also have a few questions about my blood pressure medication."

• Clinician: "Okay, great. Let's start with your annual checkup, and then we can talk about your blood pressure medication. Is there anything else you'd like to discuss today?"

• Patient: "Yes, I've also been having some trouble sleeping lately."

• Clinician: "Okay, so we have three main things to discuss today: your annual checkup, your blood pressure medication, and your sleep problems. Is there a particular order you'd like to discuss them in?"

• Patient: "Sure, let's start with the annual checkup."

In this example, the clinician uses open-ended questions to elicit the patient's concerns. The clinician then proposes an agenda for the visit, which the patient agrees to. The clinician also asks the patient if there is a particular order they would like to discuss the topics in. This shows that the clinician is respecting the patient's autonomy and priorities.

Here is another example:

• Clinician: "Mr. Jones, I see that you're here for a follow-up appointment for your back pain. How have you been doing since your last visit?"

• Patient: "I've been doing much better, thanks. The physical therapy exercises have really helped."

• Clinician: "I'm glad to hear that. I'd like to check your back pain again today, and then we can talk about any other concerns you have."

• Patient: "Actually, I've also been having some trouble with my blood pressure lately."

• Clinician: "Okay, let's go ahead and check your blood pressure now. Then, we can talk about it in more detail."

In this example, the clinician begins by asking the patient about the main reason for their visit. The clinician then proposes an agenda for the visit, which the patient agrees to. However, when the patient mentions another concern, the clinician is flexible and adapts the agenda to include that concern.

Agenda setting is an important skill for medical students to learn. By setting the agenda at the beginning of a clinical visit, medical students can ensure that they are addressing all of the patient's concerns and that the visit is focused and efficient.

The benefits of agenda-setting in clinical visits include:

• Improved patient satisfaction: Patients feel more involved in their care when they can contribute to the agenda for their visit. This can lead to improved patient satisfaction and adherence to treatment plans.

• Increased patient engagement: Agenda setting helps to ensure that all patient concerns are addressed during the visit. This can lead to improved patient engagement and participation in their care.

• Better communication between patient and clinician: Agenda setting helps to facilitate communication between the patient and clinician. By discussing the agenda at the beginning of the visit, the patient and clinician can ensure that they are on the same page and that their priorities are aligned.

• More efficient use of time: Agenda setting helps to ensure that the clinical visit is focused and efficient. By setting the agenda at the beginning of the visit, the patient and clinician can stay focused and ensure that all essential topics are covered.

• Reduced number of unaddressed concerns: The agenda-setting helps to reduce the number of unaddressed concerns at the end of the visit. This is because the patient and clinician have already discussed all of the patient's concerns at the beginning of the visit.

• Improved clinical outcomes: Some studies have shown that agenda-setting can improve clinical outcomes, such as better resolution of chronic health conditions.

Challenges to agenda-setting in clinical visits include:

• Reduced patient autonomy: Some patients may feel that agenda setting reduces their autonomy in the clinical visit. They may think that they are being rushed or that their concerns should be taken more seriously.

• Increased patient anxiety: Some patients may feel anxious about setting the agenda for their visit. They may worry about forgetting something important or not knowing what to say.

• Increased clinician workload: Agenda setting can increase the clinician's workload, as they need to take the time to discuss the agenda with the patient at the beginning of the visit. This can be incredibly challenging for clinicians who have a high volume of patients.

• Time constraints: Agenda setting can be challenging to implement in clinical settings with strict time constraints. For example, in a walk-in clinic, clinicians may not have enough time to discuss the agenda with each patient.

• Cultural factors: Agenda setting may not be appropriate in all cultures. For example, in some cultures, it is considered disrespectful for patients to question the clinician's authority.

It is important to note that these are potential counterarguments to agenda setting. The benefits of agenda-setting generally outweigh the risks. However, it is essential to be mindful of the possible counterarguments and to adapt the agenda-setting process as needed.

For example, to address the concern about reduced patient autonomy, clinicians can emphasize that patients are free to add or remove topics from the agenda at any time. To address the concern about increased patient anxiety, clinicians can provide patients with questions to consider before their visit. To address the concern about increased clinician workload, clinicians can develop templates for agendas customized for each patient. To address the concern about time constraints, clinicians can prioritize the most essential topics and reschedule less crucial topics for a follow-up visit. To address the concern about cultural factors, clinicians can learn about the cultural norms of their patients and adapt their approach accordingly.

Overall, agenda setting is a valuable skill for medical students to learn. It can help to improve patient satisfaction, communication, efficiency, and clinical outcomes. However, it is essential to be mindful of the potential counterarguments and to adapt the agenda-setting process as needed.