Monday, April 14, 2014

Should we stop dreading the lists patients bring to appointments?

- Jennifer Middleton, MD, MPH

I confess to feeling a little nervous when a patient brings a list to his or her appointment. I admit that it can be helpful at times, but I always get a flutter of irrational fear when I see a patient with one. I'm mostly afraid that the list will be a dozen pages long and/or that this particular patient encounter will be especially lengthy.

A study published in the Journal of Family Practice this month, however, has significantly decreased my anxiety. Researchers at 2 primary care offices in Israel consecutively enrolled patients who had brought a list of concerns and/or issues to their doctor's appointment; for every enrolled patient, the researchers then enrolled a patient who had not brought a list. From their Electronic Health Record (EHR), they obtained basic demographic information on each patient, along with their occupations, disease lists, medication lists, and number of visits to that office in the last year. They also asked patients who had brought a list why they brought it.

They found some differences between the patients who brought a list to their visit and those who did not. For starters, patients who brought a list tended to be older (mean age 63.0 vs 46.7 years) and retired. The patients who brought lists had more chronic medical conditions and had seen their physicians more often in the last year. Women were as likely to bring a list as men, though, and although the list-bringers received more prescriptions for benzodiazepines, the psychiatric histories between the groups was similar; list-bringers were not more likely to suffer from mental illness.

The most common reason patients gave for bringing a list was "a desire to completely satisfy the objectives of the visit." The authors cite a study which showed that lists can improve patient satisfaction without lengthening the visit time. It's not surprising that patients with more complicated medical issues are more likely to use a list. The authors state that patients who bring a list "have no discernible ill intention, and the list serves as a memory aid to help them make the most of the visit."

This study was a small one, though, and may not be generalizable to other countries. The researchers essentially used a convenience sample (whoever showed up to the office that day) and admit that they did not obtain a random sample of the office's patients. I agree with their call for further studies to either refute or confirm their findings. But, despite its limitations, this study still has me rethinking my reaction to the lists patients bring to their appointments. If you'd like to read more, check out the section titled "Improving Practice" in the AFP By Topic on Health Maintenance and Counseling.

What you think of patients who bring a list to their appointments?

1 comment:

  1. There is no need to "dread" a patient list that is brought to the office at the time of an appointment. On the contrary - a LIST is WONDERFUL - because it allows you to overview within a few seconds what patient expectations are - and what their most pressing need(s) are. The KEY - You do NOT have to cover all that is on their list. It should be easy to say, "There looks to be a lot of important issues here - but unfortunately we will not have time to cover them all today. Which one or two items is MOST important that we need to cover today?" Then offer another appointment or two to cover additional items. I used to LOVE it when patients would bring me their list of priorities.

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