THE HIDDEN AGENDA IN GP CONSULTATIONS

1. THE HIDDEN AGENDA IN GP CONSULTATIONS Dr Sunil Gupta August 2009

2. What is the Hidden Agenda in a consultation One definition � �It is when the patient�s presenting complaint is not the real reason why they have come to see the doctor�.

3. Why does the hidden agenda exist Patient embarrassed to talk about problem � sexual problem, STI, depression. Patient not sure they can trust this particular doctor. Patient worried if confidentiality will be maintained. Patient not sure if problem is legitimate problem to present to GP � bereavement, money problems, domestic abuse.

4. Some clues there may be a hidden agenda Body Language of patient � lack of eye contact, nervous, embarrassed. Problem mention by patient is very trivial. Symptoms do not make sense / inconsistent history. Characteristics of patient e.g. teenager.

5. Types of Hidden Agenda 1 � Fear they have a particular illness e.g. Cancer, Sexual transmitted infection, Heart problem etc. 2 � Issues to do with sex e.g. wanting to start contraception, have erectile dysfunction etc. 3 � Relationship problems, going through a divorce etc. 4 � Abuse � domestic violence, elder abuse, sexual abuse.

6. Types of Hidden Agenda 5 - Mental Health - Depression, anxiety, bereavement etc. 6 � Addiction e.g. alcohol, drugs, gambling. 7 - Work problem e.g. stress, long hours bullying etc. 8 � Worried about relative. 9 - Debt problems.

7. Types of Hidden Agenda 10 � The patient wants something particular from the doctor which they do not openly ask for but are not happy with the consultation unless they get it. Examples are: - Referral - Investigation e.g. x-ray, blood test - Prescription - Reassurance - Certificate to be off work

8. Way to uncover the Hidden Agenda 1- Open consultation style, let patient speak without interruptions especially at start of consultation. 2 - Establish rapport, be empathetic, sympathetic and show understanding. 3 - Summarise and reflect back to patient what they have said. 4 � Look at patient not the computer screen, pay them attention and be open to subtle cues and hints that the patient may drop.

9. Way to uncover the Hidden Agenda 5 � Give patient enough time, do not look hurried. 6 � Deal competently with trivial complaint if that is all they tell you at first. 7 � Use non verbal and verbal communication skills to find patient�s ideas, concerns and expectations.

10. Some phases which may help to uncover the Hidden Agenda Is there anything else bothering you / Is there anything else you wanted to talk about today? Are you worried these symptoms are due to anything in particular? Is there anything in particular you were hoping to get from today�s consultation? How are things at home / work / school? How is your mood?

11. Situations when GP may wish not to uncover the Hidden Agenda on a particular day Doctor running very late. Doctor not emotional ready. The Issue has particular sensitivities to the Doctor.

12. Possible Hidden Agenda of aGP in a consultation A GP may want to get something out of a consultation which may not be disclosed to the patient e.g. Collect data for Quality and Outcomes Framework. Running late so want to finish consultation quickly. Want to decrease referrals. Want to prescribe cheaper medications.

13. Other places where a Hidden Agenda can exist People can also have plans and wishes which are not out in the open at: GP Partnership meetings. Meetings between doctors and staff in a GP surgery. Meetings between GPs and the Primary Care Trust.

14. Hidden Agenda in GP Consultations Conclusion Patients sometimes do not mention the real reason why they come to see the GP. It is the job of the GP to help the patient reveal their hidden agenda in order that the patient can be helped with their problem.