Duration of opening statement of patients attending a chronic pain clinic consultation.

BACKGROUND: The opening patient statement is an important part of the medical consultation. It is where after the initial solicitation the physician gets information about the patient's current problems and concerns. Previous research shows that 23-28% of patients are allowed to complete their opening statement un-interruptedly in the general practice setting. Interruption results in fewer patient concerns expressed and failure to gather potentially important patient information. OBJECTIVES: The objective of the study was to assess the duration of opening statements of patients attending a chronic pain clinic consultation. STUDY DESIGN: Prospective observational study SETTING: Chronic pain clinic. University teaching hospital METHODS: Following written informed consent, data was collected prospectively from 100 adult patients attending a chronic pain clinic consultation at a university hospital. We recorded the time of the opening statement following a standardized opening question by the pain physician. No verbal or non-verbal interruption by the physician was made during the patient's opening statement. RESULTS: Out of 100 adult patients, 37% (n = 37) were male and 63% (n = 63) were female. Mean age (years) was 54.4. The mean opening statement time was 89 s. LIMITATIONS: The study is limited by being a single-centered study. CONCLUSIONS: The duration of opening statements of patients attending a chronic pain clinic consultation when systematically studied takes a very short amount of time. It is important that all interruptions should be avoided. Our findings should encourage physicians to allow patients to complete their opening statements un-interruptedly in the chronic pain clinic.

The role of a companion attending consultations with the patient. A systematic review.

OBJECTIVE: To review the literature pertaining to communication patterns and dynamics of doctor-patient-companion or 'triadic' medical encounters as identified in both quantitative and qualitative studies. To consider the role of an attending companion in specialist groups using the context of chronic pain as a group example. METHODS: Studies were identified via database searches and reference lists. The eligibility of studies and data extracted were cross-checked with inclusion and exclusion criteria. RESULTS: Of the 1094 titles identified, 20 studies were included for review. Tables were created for patient settings and study outcomes. Results indicated that companions frequently attended consultations, usually with a relative such as their spouse or adult child and were found to influence communicative processes in the encounter. This influence could either be negative (limiting the exchange of information, particularly relating to sensitive topics) or positive (improvement of self-care management), with study outcomes varying widely. The chronic pain subgroup has not yet been researched in the context of triadic consultations. CONCLUSION: Triadic communication can be advantageous in medical encounters; however, as differences exist depending on the individual medical setting, caution should be asserted in generalising findings.

Assessment of patient concerns: a review.

BACKGROUND: Patient-centred communication is the mainstay of the medical consultation. It includes the assessment of patient concerns and is important in building the doctor-patient therapeutic relationship. Our aim was to perform a literature review to identify relevance of patient concern assessment, to identify what concerns are encountered in various clinical settings and to explore the different methodologies used to obtain them. METHODS: A narrative review was performed. RESULTS: Addressing patient concerns is associated with increased patient satisfaction. Unvoiced concerns are associated with unresolved health issues and poor doctor-patient relationships. Different specialities have focused on different aspects of concern assessment. Patient concern assessment studies are mostly qualitative in nature. Not all qualitative methods give similar results. Interviews are more reliable sources of information than questionnaires as no one questionnaire captures all patient concerns. The location where interviews take place is also relevant. CONCLUSIONS: Assessing patient concerns is associated with positive outcomes. Patient concerns are handled differently by different clinical specialties. Various methodologies have been used for concern assessment. Interviews and questionnaires can often yield different results.