Eliciting patients' concerns: a randomised controlled trial of different approaches by the doctor

Although a 'patient-centred' approach to general practice consultation is widely advocated, there is mixed evidence of its benefits.

To measure the costs and benefits of using a prompt to elicit patients' concerns when they consult for minor illness.

An open randomised controlled trial.

Four training semi-rural general practices in the south- east of the United Kingdom.

Patients identified during the first part of the consultation as having a self-limiting illness were randomised to a second part of the consultation that was conducted 'as usual' or involved a written prompt to elicit the patient's concerns. After each consultation the doctor noted the diagnosis and the consultation length and the patient self-completed a questionnaire containing measures of satisfaction, enablement and anxiety.

One hundred and ten patients were studied. Patients in the elicitation group reported a small but significant increase in the 'professional care' score of the consultation satisfaction questionnaire (88.2 versus 80.9, mean difference = 7.3, 95% confidence interval = 2.0 to 12.6) but no other benefits were detected. Consultations in the elicitation group, however, were longer by about a minute.

Given the pressures on consultation time in general practice there must be questions about the practical value of eliciting patients' concerns if the benefit of doing so is small and the cost large.