Limiting discussion to one medical issue per visit: Know the risks

In brief

• Some doctors are coping with growing workloads and time constraints by limiting patients to “one medical issue per visit.”
• However, the possibility of not detecting serious health problems may increase if patients are limited to one issue per visit.
• Patients might also misunderstand the reason for the policy, or view it as rigid or insensitive.
• There are alternate ways of managing patient expectations.

Clinical judgment

The possibility of not detecting serious health problems may increase if patients are limited to one issue per visit. The policy may make patients feel compelled to triage their own issues or symptoms. These self-assessments may lead patients to focus on peripheral or secondary issues. Without a complete picture, physicians may arrive at an improper diagnosis or miss important health issues.

Patient relationships

Patients might misunderstand the reason for placing a limit on the number of medical issues discussed, or view the policy as rigid or insensitive. A blanket policy of "one problem per visit" may lead to negative impressions, particularly for patients who may have good reasons to not visit their doctor for every health concern, but rather "save" all their health worries for one visit. For example, such a situation might arise if a patient has to wait a long time to secure an appointment or has personal circumstances that make it difficult to schedule time with their physician.

Alternative approaches

Physicians who choose to display signage in their office may want to consider alternatives to a restrictive message that may be seen as limiting patients' access to medical care.

A message that is more informative and uses a "softer" tone is preferred. A sign that encourages patients to respect the time of others who are waiting and who also need care is more likely to be respected by patients. Many patients may be unaware of how appointments are scheduled in a medical practice and the implications of appointments that are longer than anticipated. Appropriate signage may be an opportunity for physicians to improve patients' understanding of scheduling and resource issues, while conveying that each patient's best interest is being served to the extent possible.

Another effective approach may be to ask patients to describe their concerns when an appointment is scheduled or at the beginning of the visit. This encourages open communication at the outset, and helps the physician prioritize investigation and treatment based on a more comprehensive picture of the patient's symptoms. This approach can also help assure patients that their other concerns will be addressed in subsequent visits.

A study aimed at assessing techniques to reduce patients' concerns found that the way in which a physician concludes a visit can also have an impact. When a doctor asks "Is there something else you want to address today" instead of "Is there anything else you want to address today," a patient's unmet concerns have been shown to be reduced without increasing the duration of the appointment.

Additional reading

• College complaints are on the rise: Better communication can help
• CMPA Good practices: Patient centered communication

DISCLAIMER: This content is for general informational purposes and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. Your use of CMPA learning resources is subject to the foregoing as well as CMPA's Terms of Use.