Table 2 Descriptions and examples of visit openings
Type of Visit Opening | Definition | Example visits (target lines that define the visit opening have been bolded) |
|---|---|---|
NO AGENDA SETTING | Physician and patient discuss topic(s) without physician first agenda setting. | See examples in open-ended question, patient launch, and physician launch. |
Open-ended question | Physician begins visit by asking a broad open-ended question. In response, the patient proposes a first topic and this topic then gets discussed. This open-ended question does not explicitly ask for list of topics, nor is it followed by agenda reframing. | 01 PAT: Hello Dr. <Name>. 02 DOC: What brings you in today? 03 PAT: I was trying to get a paper to bring in for you to fill it out, but I didn’t get it. 04 DOC: Paper for what? 05 PAT: Uh- 06 DOC: Disability? 07 PAT: No, from ((inaudible)) housing. 08 DOC: Oh, okay. 09 PAT: You know how they say you’re only eligible for one bedroom apartment? 10 DOC: Mm hmm 11 PAT: And the lady -- uh -- has said -- I was telling her, I said, “Well, I stayed in 12 ((location)),” I said, but they told me I couldn’t stay there by myself. 13 DOC: Mm hmm 14 PAT: I said, so I’m not there anymore. So. She say she mailed tomorrow and get it. 15 DOC: Where are you living now? 16 ((patient’s housing situation continues to get discussed)) Pt 118 |
Patient launch | Patient begins visit by initiating a first topic, and physician pursues this topic. | 01 PAT: Okay. The first thing I wanna ask is the hospital called me about- for pain 02 management from the spine clinic. 03 DOC: Mm hmm 04 PAT: Um, but they won’t do anything until after you give the okay. 05 DOC: Okay. So, my question is, um, I’m not sure if I should- who -did they say 06 exactly how I was supposed to give the okay? Pt 314 |
Physician launch | Physician begins visit by initiating and pursuing a first topic. | 01 DOC: So, the last time you came to our clinic, you had a cough. How is that 02 doing? 03 PAT: Uhh, still around, right? But it’s kind of leaving. Like, for one, she didn’t give me 04 enough medication. 05 DOC: Prednisone, or-? Pt 249 |
AGENDA SETTING | Physician sets an agenda before discussing first topic. | See examples in agenda eliciting and agenda reframing. |
Agenda eliciting | Physician begins visit by explicitly asking patient for a list of their topics. While this question is open-ended, the inquiry solicits a narrowed topic list [52]. | ((visit opens with greetings; COM = patient’s companion)) 07 DOC: Was there anything in particular you guys wanted to address? 08 COM: His potassium level 09 DOC: Yeah. Okay. 10 COM: His phantom pain. 11 DOC: Uh huh 12 COM: And uh, the chest X-ray. We never really discussed that last time. Pt 17 |
Agenda reframing | Visit begins by either the physician asking a broad open-ended question or the patient launching into a first topic (see definitions below). The physician, however, does not engage with the patient’s proposed first topic but instead reframes the patient’s talk into a visit agenda. This definition requires that the opening lines do not meet the definition of agenda eliciting; agenda reframing is counted as agenda setting because the physician pauses to establish the agenda before discussing the first clinical topic. | 01 DOC: What can I do for you today? 02 PAT: I’m not doing no good. 03 DOC: Oh, not doing so good? Why is that? 04 PAT: ‘Cuz I’ve been having fever now and then. Then I started coughing, and by now, 05 I’m coughing a lot. 06 DOC: Okay. 07 PAT: And yesterday, I couldn’t even talk, my throat was so bad. 08 DOC: Oh, was it a sore throat? 09 PAT: Mm hmm 10 DOC: Okay. You were coming in today to talk about fever, cough, all those things? 11 PAT: Yeah, ‘cuz I called over here because I haven’t checked my Coumadin yet. 12 DOC: Mm hmm 13 PAT: She told me since I was gonna come over here, it was worth it for me to come and 14 see the doctor. 15 DOC: Okay. 16 PAT: ‘Cuz my legs feel real restless. 17 DOC: Okay. So, well, let’s—we’ve got to, you know, decide, you know, a couple of 18 things to talk about today. It sounds like number one, you were coming in- 19 you have fever and a cough, sore throat? 20 PAT: Mm hmm 21 DOC: Then you say that another thing is, your legs feel restless. 22 PAT: Mm hmm. 23 DOC: Okay. 24 PAT: My legs feel restless a lot. I can’t even stand it sometimes. 25 DOC: Okay. 26 PAT: I keep rubbing my legs on the bed, or one or the other, and it still won’t go away. 27 DOC: Okay. All right. Let’s talk about, first, the fever and cough and all that 28 stuff. When did that start? Pt 432 |