Screening for other problems

Screening for the problems that the patient wishes to discuss is not only time-efficient but helpful to the patient by reducing anxiety and blocking. Research clearly shows that the order patient’s present problems in is not related to their importance and that by exploring the first one offered, we make important complaints arise late in the consultation or worse not at all.

Screening naturally leads to agenda-setting and negotiating – an overt, involving the method of establishing how the interview will proceed.

Advantages of screening for the doctor:

  • increased chance of discovering the patient’s full agenda
  • increased chance of pacing the interview appropriately
  • allows you to check your assumptions and keep an open mind esp. in the review app.
  • allows agenda setting and open discussion of time limitations

Advantages for the patient:

  • reassurance that you ware interested in their problems
  • stops the anxiety of a hidden agenda item blocking communication
  • encourages a collaborative open approach

Screening will not stop all late arising complaints – the most emotional may still come late and that’s OK.

The tension between listening and screening is aided by this plan:

  • Allow talking without interruption until stop, encourage but do not move into clarifying a particular problem (remember that repetition at this part of the consultation acts as an encouragement to further explore one problem)
  • Value the first problem (“that’s clearly important – we must go into that carefully”) Signpost the screen (“just so I can plan the consultation better”) and why
  • Anything else? (“is there anything else that you want to tackle today as well”) – continue until get a “no”
  • Check topics and agenda (summarising and checking)
  • Add in your agenda if necessary
  • Prioritise and negotiate an order or possibility of covering today in the time
  • Only then move on to explore topics.
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