Purpose Little is known about patients who present a written list during a medical consultation. In this preliminary study, we sought to examine and characterize patients who use a prepared list.
Methods The design was an open observational case-controlled study that took place at 2 urban primary care clinics. We enrolled patients consecutively as they arrived with a written list for consultation. Consecutive patients presenting without a list served as the control group. Physician interviews and completed questionnaires provided demographic and medical characteristics of this group and explanations for list preparation.
Results Fifty-four patients presented with a list and were compared with controls. Statistically, patients arriving with a list were significantly more likely to be older and retired, and less likely to be salaried workers or housewives. These patients had more chronic diseases and consumed more long-term medications. They had a greater number of doctor visits in the past year compared with controls, and perceived an increase in memory loss. There were no differences between the groups in terms of psychiatric disease or personality disorders.
Conclusions Aside from certain demographic and health characteristics, patients who use written lists do not differ substantially from those who don’t. They have no discernible ill intention, and the list serves as a memory aid to make the most of the visit.
Nonverbal communication is a significant part of the physician-patient encounter, in part revealing clues to underlying attitudes and emotions or indicating whether one agrees or disagrees with expressed statements.1 Nonverbal communication exhibited by both doctor and patient strongly influences how each participant perceives the encounter and helps determine how the physician-patient relationship will develop.2-4
Patients, for example, are affected by the amount of physician eye contact and computer use. Less eye contact and greater attention to the computer tend to lower patients’ opinions of the consultation.1,5 These and other behaviors may contribute to the finding that 30% to 80% of patients feel their expectations are not met in routine primary care visits.6
Physicians, despite attempts to remain nonjudgmental, can be affected by a patient’s demeanor on entering the consulting room. Subtle prejudices may be evoked by age, gender, ethnicity, manner of dress, tone of voice, mannerisms, cell phone interruptions, and the like.7,8 Negative reactions can create barriers to good communication. Awareness of them may be the first step to preventing or removing hindrances to meaningful dialogue.9
One aspect of a patient’s presentation that may be viewed negatively is possession of a list. But this need not be the case. The list, if viewed as a patient-initiated agenda, can lead to a gratifying encounter for both patient and physician. In fact, there is reason to believe that a list representing a set agenda at the start of a visit may enhance patient satisfaction without increasing visit length.10 In fact, the Agency for Healthcare Research and Quality (AHRQ) advises patients to “Write down your questions before your visit. List the most important ones first to make sure they get asked and answered.”11
To learn more about the people who arrive at a consultation with a written list, we conducted a study at 2 clinics in Clalit Health Services—Southern District (CHS-SD), which we designed to focus on answering the following questions:
1. Do patients with lists have a unique sociodemographic profile?
2. Do they present with specific medical ailments but have a high frequency of psychiatric disorders?
3. What are the underlying motives leading to list use?
This was an open observational case-controlled study, approved by the institutional review board and the clinical research board of the Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
We conducted our study at 2 urban primary care clinics serving a population of 7000 people of diverse ages, 10% of whom are recent immigrants.
Selection of participants
We consecutively recruited patients who carried a list to use during the consultation. After obtaining patients’ informed consent to participate in the study, we asked them to spend the time necessary to disclose requested information. We excluded those who were not fluent in the language of their physicians.
Family physicians at the participating clinics distributed a questionnaire to patients arriving with a written list, then conducted guided interviews. We defined “list use” as the patient’s choice to refer to a list as an agenda for that visit, whether to remind one’s self to cover all complaints, to accurately describe symptoms, to request medication prescriptions, or to ask about test results.