Primary Care Research

Changing one word in a question from the doctor can dramatically reduce patients' unmet concerns in primary care

About 40 percent of patients bring more than one concern to primary acute care visits. Yet, often these concerns are left unaddressed, leading to worsening medical problems, patient anxiety, and costly additional visits. After a patient mentions the chief concern for their visit, doctors should simply ask, "Is there something else you want to address in the visit today?" In a new study, this simple question reduced patients' unmet concerns by 78 percent.

Textbooks on medical interviewing recommend that doctors ask, "Is there anything else you want to address in the visit today?" Yet, use of this question in the current study did not reduce the incidence of patients' unmet concerns compared with a control group.

The negative polarity of the single word 'any' with its subtle communication of an expected 'no' response, tends to ruin the opportunity to raise unmet concerns that the question might otherwise create, explains John Heritage, Ph.D., of the University of California, Los Angeles. He and coinvestigators asked 20 physicians from 20 community-based family practices to conduct 4 patient visits in normal fashion (control visits). The researchers then randomly assigned the doctors to ask one or the other question in seven additional visits after they watched an educational video on the topic. Over one-third (37 percent) of patients with more than one concern in the control group had unmet concerns that were not trivial. Yet, less than 5 percent of these patients were asked about additional concerns. Patients with more than one previsit concern gave more affirmative responses to the "something" than the "anything" question (90 vs. 53 percent). The simple "something" question eliminated more than three-fourths of all cases of unmet concerns. In contrast, unmet concerns were similar for the control and the "anything" question group. Visit length was not affected by asking either question.

The study was supported by the Agency for Healthcare Research and Quality (HS13343).

See "Reducing patients' unmet concerns in primary care: The difference one word can make," by Dr Heritage, Jeffrey D. Robinson, Ph.D., Marc N. Elliott, Ph.D., and others, in the October 2007 Journal of General Internal Medicine 22(10), pp. 1429-1433.

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