"By The Way..."Phenomenon: A Qualitative Study of the Additional Demands in Closing Moments of Medical Interview in Family Medicine

Abstract

Objective: To identify and characterize, the additional demands (ADs) in the family medicine practice. Participants and Methods: A qualitative, observational, narrative study, to explore the demand that occur at the end of the visit, with the presentation of a new query motif that is added to the previous one, once this one is finished, from June to August, 2017, in a family medicine office in Toledo, Spain, was carried out, by recording the words used by the patient. From a randomly selected date we included all patients performing additional demand until data saturation. An analysis of the content of the demands collected of each patient included was carried out. The technique to control bias was methodological triangulation between the results obtained with the data that had been reported in the literature. Results: A total of 116 ADs were included, of which 85 (73%) were from female patients and 31 (27%) were from male patients. The age range was 14 to 91 years. The categories that were assessed as with very high or high importance were: 1) What seems to concern or interest the patient more in that moment or it seems to be the most important or the main reason for the doctor at that time, including the consultation on a chronic topic that presents itself as new; 2) What is related or insists in some way on the previous demand and expresses an action to act, or a fear of the previous demand; 3) to sleep or to “nerves”; 4) more than a demand is a story (usually psycho-social); and 5) demand for another family member present or absent in the consultation. The additional demand phrases that began with the conjunction “And ...” (In addition to) were the most frequent, followed by those that began with “And ... another thing ...”, “Ah!” or “Oh!” (An interjection used to express surprise), and “And since I’m here ... “or” By the way ...”. Conclusions: Although some ADs seem to occur in a random manner and to be a superfluous request, most of them, however, can contain issues that most concern the patient or are rated as more important by the physician. ADs with some psychosocial content are the most frequent and important. But, its aspect of commonplace demands, make it difficult to take them into account. Family doctor never should underestimate any demand in closing moments of medical interview of the patient, especially if its content is partly psychosocial, since that may be the real and important motive that led him or her to the consultation. Therefore, a pragmatic, unstructured and strategic interview can be proposed: from where the doctor and the patient can go, in zigzag, “through the field instead of going the path”, taking advantage of the opportunities, as the appearance of ADs.