Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns?

•Physicians rarely solicit patients' additional agendas after the chief complaint.•Some question formats are more effective at soliciting patients additional agendas.•Asking questions before the completion of history taking is more effective than later.

ObjectiveSoliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions.MethodsWe coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses.ResultsPhysicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p < .001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., “Do you have any questions?”), those that were formatted so as to allow for 'concerns' (e.g., “Any other concerns?”) were significantly more likely to generate some type of agenda item (Chi2 (1, N = 131) = 11.96, p = .001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi2 (1, N = 73) = 4.99, p = .025).ConclusionsAgenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions.Practice implicationsPhysicians should increase use of optimized forms of agenda setting.