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Open and hidden agendas of "asymptomatic" patients who request check-up exams.

Hunziker S, Schläpfer M, Langewitz W, Kaufmann G, Nüesch R, Battegay E, Zimmerli LU - BMC Fam Pract (2011)

Bottom Line: The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease.The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues.Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Outpatient Division/Ambulatory Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.

ABSTRACT

Background: Current guidelines for a check-up recommend routine screening not triggered by specific symptoms for some known risk factors and diseases in the general population. Patients' perceptions and expectations regarding a check-up exam may differ from these principles. However, quantitative and qualitative data about the discrepancy between patient- and provider expectations for this type of clinic consultation is lacking.

Methods: For a year, we prospectively enrolled 66 patients who explicitly requested a "check-up" at our medical outpatient division. All patients actively denied upon prompting having any symptoms or specific health concerns at the time they made their appointment. All consultations were videotaped and analysed for information about spontaneously mentioned symptoms and reasons for the clinic consultation ("open agendas") and for cues to hidden patient agendas using the Roter interaction analysis system (RIAS).

Results: All patients initially declared to be asymptomatic but this was ultimately the case in only 7 out of 66 patients. The remaining 59 patients spontaneously mentioned a mean of 4.2 ± 3.3 symptoms during their first consultation. In 23 patients a total of 31 hidden agendas were revealed. The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease.

Conclusions: The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues. Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.

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Overview of results with respect to determining the presence of hidden patient agendas.
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Figure 1: Overview of results with respect to determining the presence of hidden patient agendas.

Mentions: The study setting and study participants' demographics are depicted in Figure 1 and table 1 respectively. A total of 93 patients met the inclusion criteria, of whom 25 (28%) patients did not give consent for the consultation to be videotaped and one patient was excluded for technical reasons. A total of 66 patients gave informed consent and their baseline consultation was videotaped successfully and analysed. Nine of the 66 patients (14%) were lost to follow-up. In 25 (38%) of the patients, the check-up examination revealed previously undiagnosed conditions (data not shown), most commonly mood disorders, including depression, and anxiety disorders, dyslipidemia, and hypertension.


Open and hidden agendas of "asymptomatic" patients who request check-up exams.

Hunziker S, Schläpfer M, Langewitz W, Kaufmann G, Nüesch R, Battegay E, Zimmerli LU - BMC Fam Pract (2011)

Overview of results with respect to determining the presence of hidden patient agendas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3094231&req=5

Figure 1: Overview of results with respect to determining the presence of hidden patient agendas.
Mentions: The study setting and study participants' demographics are depicted in Figure 1 and table 1 respectively. A total of 93 patients met the inclusion criteria, of whom 25 (28%) patients did not give consent for the consultation to be videotaped and one patient was excluded for technical reasons. A total of 66 patients gave informed consent and their baseline consultation was videotaped successfully and analysed. Nine of the 66 patients (14%) were lost to follow-up. In 25 (38%) of the patients, the check-up examination revealed previously undiagnosed conditions (data not shown), most commonly mood disorders, including depression, and anxiety disorders, dyslipidemia, and hypertension.

Bottom Line: The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease.The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues.Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Outpatient Division/Ambulatory Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.

ABSTRACT

Background: Current guidelines for a check-up recommend routine screening not triggered by specific symptoms for some known risk factors and diseases in the general population. Patients' perceptions and expectations regarding a check-up exam may differ from these principles. However, quantitative and qualitative data about the discrepancy between patient- and provider expectations for this type of clinic consultation is lacking.

Methods: For a year, we prospectively enrolled 66 patients who explicitly requested a "check-up" at our medical outpatient division. All patients actively denied upon prompting having any symptoms or specific health concerns at the time they made their appointment. All consultations were videotaped and analysed for information about spontaneously mentioned symptoms and reasons for the clinic consultation ("open agendas") and for cues to hidden patient agendas using the Roter interaction analysis system (RIAS).

Results: All patients initially declared to be asymptomatic but this was ultimately the case in only 7 out of 66 patients. The remaining 59 patients spontaneously mentioned a mean of 4.2 ± 3.3 symptoms during their first consultation. In 23 patients a total of 31 hidden agendas were revealed. The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease.

Conclusions: The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues. Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.

Show MeSH