This week, I would like to talk about how important it is to set the agenda for your doctor’s visit. I think it is by far the most important part of the encounter. It is the time when you tell the doctor what you want to discuss today. If you set the agenda properly, then your time with the doctor will be more fruitful. If you do not, then questions which are important to you can be missed or delayed. 

I first learned the importance of agenda setting in my third year of my internal medicine residency. Once a year, my residency required a psychologist to review a patient encounter with me. This encounter was videotaped with the patient’s consent so that we could analyze it later. The psychologist looked at this encounter and saw that we started addressing the patient’s toe pain first, which took most of our time. At the end of the visit the patient mentioned that he had chest pain. This turned out to be the critical subject for the visit and it extended his visit well into the next patient’s appointment time.  

I think you should start by asking a simple question, one that I am rarely asked by my patients: How much time do we have? This question is crucial. It gives you an idea of how many topics you can address today. Also, the doctor will love you for it. It will make him/her feel like you respect their time. On a daily basis, patients ask me questions at the end of their visit that then prolong the visit another 10-20 minutes. I don’t mind spending that amount of time with my patients; however, it takes away time that I get to spend with my other patients. 

The next thing you should do is list the concerns that you want to address during your visit. Do not be afraid to list everything. Your doctor will typically listen for the most medically concerning and recommend that you both focus on those today and address the others at a follow up visit if time does not allow. There is a big difference between chest pain and toe pain. By listing everything up front, you let the doctor sift through your concerns and to arrange a template in his/her mind for how the visit can be most productive. If you have written down a physical list, hand it to your doctor so they can review your concerns. 

Also, if you briefly list all of your symptoms up front, a good doctor will start looking for a unifying diagnosis that links them together. Sometimes your symptoms may be unrelated, but other times, the doctor may discover that all of your symptoms are caused by one single ailment. Remember to keep it short because your doctor will likely want to ask follow up questions to better clarify your symptoms. 

By properly setting the agenda, you can prioritize the most important issues for the day. You can plan ahead as to whether everything will be addressed today, or if a follow up visit will be needed. And you can help the doctor by getting all of the information on the table before we start to process everything. 

As I said in my intro, being a Wise Patient can lead to more productive office visits and better medical outcomes, and I believe that all starts with agenda setting.