Asking “Is there something else?” decreases patients’ unmet concerns

Asking “Is there something else?” decreases patients’ unmet concerns

Daily POEMs

February 2008

Clinical question
Can specific wording make a difference in addressing patients’ unmet concerns?

Bottom line
After eliciting a patient’s chief concern, asking “Is there something else you want to address in the visit today?” decreases the likelihood of them leaving with unmet concerns. Asking this variation of the more typical, “Is there anything else you want to address in the visit today?” did not increase the average visit duration. The authors did not study whether patient satisfaction was improved. (LOE = 2b)

Reference
Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M. Reducing patients’ unmet concerns in primary care: the difference one word can make. J Gen Intern Med 2007;22(10):1429-1433. [PubMed abstract]

Study design: Cross-sectional

Allocation: Unconcealed

Setting: Outpatient (primary care)

Synopsis
Most patients have 3 concerns to address during a primary care visit, though typically they are asked to name one problem at the start of the visit. As a result, patients typically leave with a concern that was not addressed or even mentioned. The authors of this study sought to determine whether a simple wording change to the typical question, “Is there anything else you want to address in the visit today?” increases the identification of patients’ concerns. They randomly assigned 20 US family medicine physicians in community practices to 1 of 2 groups. Both groups of physicians were given a short tutorial instructing them to follow the identification of a patients’ chief concerns with 1 of 2 questions: “Is there ANYthing else you want to address in the visit today?” or “Is there SOMEthing else you want to address in the visit today?” The physicians were prompted via Post-it notes in the patients’ medical charts. On average, each physician asked the question of 11 consecutive patients who presented with an acute problem. Of patients (37%) who identified more than one concern on a previsit questionnaire — not shown to their physician — the use of the word “something” rather than “anything” increased the number of “yes” responses (90.3% vs 53.1%; P = .003). This simple adjustment to the wording of the question decreased 78% of patients’ unmet concerns. Increasing the identification of patient concerns did not increase visit length (average = 11.4 minutes; standard deviation = 5 minutes).

Copyright© 2008 John Wiley & Sons, Inc. www.infopoems.com


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