Eliciting patients' concerns

I read this paper by Maclean and Armstrong¹ with keen interest. Indeed, my Registrar Day Release Group chose this paper for further study this week. This original work raised important issues, questioning the place of patient-centredness on our agenda as educators in general practice. What if our concern to know our patients' concern is indeed misplaced? Has all the time I have spent over these past 15 years eliciting patient concerns been vain hope and glory?

The authors recognise the limitations of their work, and specifically question the sample size and the possibility that further benefits may be proven by a larger study. However, they assert that the ‘increased cost in terms of consulting time seems intuitively right’. It is this assertion that is at odds with the results of the study itself wherein they conclude that there was, in fact, no statistically significant difference between consultation times in the two arms of this trial. How can the authors proceed to question the importance of patient-centredness based on this false premise?

Freeman et al, rightly reflects the shortcomings of this paper in his editorial, although he does gives credit to the authors for having helped prove the importance of seeking patients' concerns in terms of patient satisfaction.² I trust this paper stimulates healthy debate, but we would do well to question our intuition — especially when the facts question our misconceptions.