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Fam Pract Manag. 2010;17(1):10-12

As a retired family physician who spends more time in medical offices as a patient these days than in the past, I read “What Should You Do When Your Patient Brings a List?”May/June 2009, with great interest. That's because I routinely give my family physician a list of my active problems, medications and any current health concerns. The sheet is typed in duplicate; one copy is handed to a staff member at the beginning of the visit. That enables the doctor to look it over before he enters the exam room, and we each have a copy to glance at as we talk.

This procedure has two basic goals: to ensure that nothing important gets overlooked and to make the encounter as time-efficient as possible. He has been gracious in meeting my medical needs, and I try to return the favor by keeping my visits as brief as those needs will permit. It all works well, and we usually have time for a minute or two of non-medical conversation before he goes on to his next patient.

As the article indicates, patient-generated problem lists are often prepared for different reasons, some of which the authors have listed – to help the patients remember what they want to ask, to help set the agenda for the visit or just because they were told to write it all down for the doctor to read. The hard fact is that our population is getting older, which means that many patients have multiple health problems to manage. This suggests that patient-generated lists serve a useful purpose and aren't going to go away.

That doesn't mean that all such lists are necessarily created with the noblest of motives. A certain amount of manipulative behavior is to be expected in human interactions. A small but significant number of patients try to control their doctor inappropriately, and dealing with that can be irritating. The solution is to act like a partner in the patient's medical care, not as a hired servant.

Having the patient's list in hand before entering the examining room lets you decide in advance which items will be addressed today and which will be politely deferred. This is where the article's five steps come into play: acknowledge the list, negotiate what to cover, mutually set the agenda, surface any remaining concerns and plan for the next visit. That approach builds rapport, minimizes physician errors and reduces the risk of misunderstandings.

The authors of the article got it right – the best response to patient lists is not to dread them but to use them to “build bridges” with the patient and work together to negotiate a realistic plan for the encounter.


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