Eliciting patients' views of the cause of their problem: a practical strategy for GPs

One thousand consecutive consultations with one general practitioner were studied to determine the value of seeking the patients' ideas about the cause of their condition. The diagnosis was an issue in 543 of the consultations. A total of 150 patients spontaneously volunteered a clear cause. When the remainder were asked to express their ideas about cause, 266 were able to do so. There were no significant age or sex differences between those who were able to express a cause compared with those who were unable to. The most common ideas expressed were infection, injury, anxiety and allergy. Thirty per cent of ideas were valuable to the doctor in reaching a deeper understanding of the patient's concerns over the condition and 20% helped determine the most likely cause of the condition. There were no significant differences in the value to the doctor between the causes spontaneously volunteered and those given as a result of questioning. The most valuable ideas to the doctor were cancer, anxiety, age, occupation, and heart disease. This study suggests that in the half of general practitioner consultations in which diagnosis is an issue, it is worthwhile seeking the patients' ideas as to cause of their condition.