Johanna Shapiro, PhD
The importance of reconciling conflicting agendas and establishing a common or shared agenda is such that it has become the focus of a variety of educational approaches. Interviewing techniques have been developed to help practitioners identify and elicit the patient’s agenda. Teaching physicians specific skills related to eliciting patient concerns and clarifying the patient’s perspective has been demonstrated to significantly reduce patient emotional distress. Yet a recent study of experienced family physicians found that more than two thirds tended to redirect and focus the interaction before the patient’s full agenda was elicited. When patients are considered “difficult” by their physicians, the problem of disparate doctor/patient agendas is further complicated. Patients who are extremely frustrating for physicians to work with can engender a range of negative emotions in their doctors, including anxiety, anger, and guilt. Unless these emotions are adequately managed, they may result in persistent difficulties in establishing a physician-patient alliance.