Five Steps to Mastering Agenda Setting
Use this guide to up-front agenda setting to help you strike a balance between meeting complex patient needs and staying on time.
Fam Pract Manag. 2021 Mar-Apr;28(2):27-31.
Author disclosures: no relevant financial affiliations disclosed. Note: No actual patient names have been used.
Mrs. Lister is a 74-year-old female who comes to you for an annual visit. She has a past medical history of Type 2 diabetes, coronary artery disease with a myocardial infarction and stent placement three years prior, hypertension, hyperlipidemia, obesity, and tobacco use. She obtained labs prior to the visit, which show an A1C of 8.9%, an increase from 8.1% six months prior. Her blood pressure is 148/91 mm Hg at today's visit, verified by repeat testing. The rooming staff informs you that a depression screen was positive — and then warns you, “Watch out! She has a list with her.”
This scenario is not unique. In family medicine, we often find ourselves with too little time to address a patient's multitude of medical concerns. The way we navigate this situation can determine whether we are timely and effective, or frustrated and late. Properly using time during a visit improves the care we give our patients and how they perceive that care.1 In situations like the one with Mrs. Lister, we want to stay on time, provide quality care, ensure that our patients feel cared for, and avoid getting burnt out in the process. We can accomplish this through effective agenda setting.
Effective agenda setting is a learned skill, and like any learned skill it takes practice to obtain mastery. When properly performed, agenda setting is rapid and unambiguous, and it facilitates clear communication of priorities between you and your patient. Here are some steps you can follow to become a master of agenda setting.
When presented with a list of concerns that are impossible to address adequately during a single visit, agenda setting can help balance patient needs and physician time constraints.
Like any learned skill, agenda setting takes practice. This article offers a simple framework and some sample language you can try using with patients.
The agenda-setting process includes eliciting all patient concerns at the start of a visit, estimating the time required, establishing priorities for the current visit, creating a plan for addressing remaining concerns at subsequent visits, and checking for understanding.
1: CREATE A COMPLETE LIST OF CONCERNS
The agenda-setting process allows you to create a plan for how time will be spent during a patient encounter. Although the agenda should be negotiated with the patient, ultimately you are responsible for finalizing it. The process of agenda setting begins by compiling a complete list of the items to be discussed.2,3 We call this the concern list, and it includes everything of interest to you or your patient.
You might start by jotting down your concerns as you review the patient's chart. Then, as you begin the visit, ask the
For additional guidance, see the AAFP TIPS resource on agenda setting (free to AAFP members).
Referencesshow all references
1. Robinson JD, Heritage J. How patients understand physicians' solicitations of additional concerns: implications for up-front agenda setting in primary care. Health Commun. 2016;31(4):434–444....
2. Kowalski CP, McQuillan DB, Chawla N, et al. ‘The hand on the doorknob’: visit agenda setting by complex patients and their primary care physicians. J Am Board Fam Med. 2018;31(1):29–37.
3. Gobat N, Kinnersley P, Gregory JW, Robling M. What is agenda setting in the clinical encounter? Consensus from literature review and expert consultation. Patient Educ Couns. 2015;98(7):822–829.
4. Dyche L, Swiderski D. The effect of physician solicitation approaches on ability to identify patient concerns. J Gen Intern Med. 2005;20(3):267–270.
5. Baker LH, O'Connell D, Platt FW. “What else?” Setting the agenda for the clinical interview. Ann Intern Med. 2005;143(10):766–770.
6. Li RC, Garg T, Cun T, et al. Impact of problem-based charting on the utilization and accuracy of the electronic problem list. J Am Med Inform Assoc. 2018;25(5):548–554.
7. Hashim MJ. Patient-centered communication: basic skills. Am Fam Physician. 2017;95(1):29–34.
8. Kane M, Chambliss ML. Getting to no: how to respond to inappropriate patient requests. Fam Pract Manag. 2018;25(1):25–30.
9. Centrella-Nigro AM, Alexander C. Using the teach-back method in patient education to improve patient satisfaction. J Contin Educ Nurs. 2017;48(1):47–52.
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