To the Editor:

I appreciated the practice management pearl “Patients With Lists” [“Tailoring New Physicians to Fit Your Practice,” April 2001, page 39] and would like to offer some additional thoughts. Although many physicians dread patients’ lists, I believe we should welcome them. Patients who bring lists have thought through what they want to accomplish at their visit (even if their plans are unrealistic), and they are less likely than others to add an “Oh, by the way” question as the doctor reaches for the doorknob.

On average, each patient has a list of three concerns, written or not. If the patient doesn’t bring the list, the doctor has to elicit it. This can be done using a technique I learned from the American Academy on Physician and Patient (AAPP). Using this technique, the physician makes a friendly introduction and then says to the patient, “I see you are here about ‘x’ today. Were you hoping to cover any other topics at today’s visit?” The physician then asks “Anything else?” or “Any other concerns?” until the patient has no other concerns to add. Finally, the physician and patient negotiate which problems will be managed today and which require another appointment. This technique helps uncover and manage the list and also helps prevent important problems from surfacing inappropriately.

After practicing this technique for the past couple of years, I know it works. It has improved my outlook toward the dreaded “list” by promoting honesty in negotiation, helping my patients maintain control and allowing me to be a good steward of my other patients’ waiting time.