Expanding the Scope of the Visit: Which Patient-Initiated Additional Concerns Receive Help?

ABSTRACT

This study examines patient-initiated additional concern presentations in general surgery visits to assess which factors contribute to them getting “helped.” Concern presentations were analyzed for a variety of design features (e.g., social action (inquiry vs. informing), when patients initiate during a visit, how patients fit topic to previous talk or activity) and contextual factors (e.g., concern falls inside or outside surgeon’s domain of expertise, chronic vs. acute concern-types, the history of the patient-physician relationship). This study uses a mixed-methods approach, combining case-level conversation analysis and aggregate-level statistical analysis. Data are video recordings of office visits from 2013–2015, with a longitudinal focus of following the same patients across time. In total, 62 patients spanning 175 visits were analyzed. 377 patient-initiated additional concerns were found, and 188 received help. Several factors were found to increase the likelihood of patients’ concerns getting helped such as designing the concern as an inquiry, raising the concern early in the visit, and mentioning the concern more than once. These findings can help guide patients on how to better design additional concerns presentations to receive help and can benefit physicians by identifying more subtle practices patients are already using to broach concerns to help reduce unnoticed or unhelped concerns.

Acknowledgments

I am very appreciative of the patients and surgeons who participated in this study. Without their willingness, and the clinic staff’s assistance, this study would not have been possible. I am also very thankful to John Heritage, Tanya Stivers, Jack Katz, Mimi Tarn, Federico Rossano, Lisa Chiang, and the reviewers for their invaluable comments and support.

Additional information

Funding

I am supported by Health Resources and Services Administration grant [T32HP30037] through the Quality, Safety, and Comparative Effectiveness Research Training (QSCERT-PC) Program.