The effect of physician solicitation approaches on ability to identify patient concerns

CONTEXT: Studies showing that physicians often interrupt the patient's opening statement assume that this compromises data collection. OBJECTIVE: To explore the association between such interruptions and physician accuracy in identifying patient concerns. DESIGN: This study replicates the Beckman-Frankel methodology and adds exit interviews to assess physician understanding. The authors audiotaped a convenience sample of 70 encounters and surveyed both parties following the visit. SETTING: A community-based ambulatory clinic. PARTICIPANTS: Internal medicine residents (77%) and attending physicians and their adult, English-speaking patients who were primarily low income and ethnic minority. OUTCOME MEASURE: The Index of Understanding measures patient-physician problem list concordance. It is the percentage of patient problems, obtained on exit, that the physician correctly identifies. RESULTS: In 26% of the visits, patients were allowed to complete their agenda without interruption; in 37% the physicians interrupted; and in 37% no inquiry about agenda was made in the first 5 minutes. Neither physician experience nor their assessment of time pressure or medical difficulty was associated with these rates. Exit interviews showed no significant difference in Index of Understanding between those involving completion of agenda (84.6%) and those involving patient interruption (82.4%) (P=.83). But when the physician did not solicit an agenda, the concordance was 59.2%, significantly lower than either the completion (P=.014) or the interruption group (P=.013). CONCLUSION: Interruption as defined by Beckman-Frankel does not curtail ability to identify patient concerns, but failure to ask for the patient's agenda associates with a 24% reduction in physician understanding.