Paskins Zoe, Sanders Tom, Croft Peter R, Green Julie, McKinley Robert, Hassell Andrew B
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, Staffordshire, UK.
Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, Staffordshire, UK.
Fam Pract. 2018 Dec 12;35(6):706-711. doi: 10.1093/fampra/cmy023.
Symptoms form a major component of patient agendas, with the need for an explanation of symptoms being a prominent reason for consultation.
To estimate the prevalence of different symptoms pre-consultation, to investigate whether intention to mention a symptom in the consultation varied between patients and across symptoms, and to determine how patients' intended agendas for mentioning symptoms compared with what was discussed.
We videorecorded consultations of an unselected sample of people aged 45 and over consulting their GP in seven different practices in UK primary care. A pre-consultation questionnaire recorded the patient's agenda for the consultation, current symptoms and symptoms the patient intended to discuss with their GP. The videorecorded consultation was viewed and all patient agendas and 'symptoms with intention to discuss' were compared with the actual topics of discussion.
Totally, 190 patients participated. Eighty-one (42.6%) were female and the mean age was 68 (range 46-93). Joint pain was the most commonly reported symptom. One hundred thirty-nine (81.8% of those reporting symptoms) patients reported intention to discuss a symptom. In 43 (22.6%) consultations, 67 symptoms (27.2%), where an intention to discuss had been expressed, remained undisclosed. Tiredness and sleeping difficulty were more likely to be withheld than other symptoms after an intention to discuss had been expressed. Of the more physically located symptoms, joint pain was the most likely to remain undisclosed.
This study suggests that the extent of symptom non-disclosure varies between patients, physicians and symptoms. Further work needs to explore the consequences of non-disclosure.
症状是患者就医议程的主要组成部分，寻求对症状的解释是患者就诊的一个突出原因。
估计就诊前不同症状的患病率，调查患者在就诊时提及症状的意愿在患者之间以及不同症状之间是否存在差异，并确定患者提及症状的预期议程与实际讨论内容的对比情况。
我们对英国初级医疗中七家不同诊所里45岁及以上未经过挑选的患者样本向全科医生就诊的过程进行了录像。一份就诊前问卷记录了患者的就诊议程、当前症状以及患者打算与全科医生讨论的症状。观看录像就诊过程，并将所有患者议程和“打算讨论的症状”与实际讨论话题进行比较。
共有190名患者参与。81名（42.6%）为女性，平均年龄为68岁（范围46 - 93岁）。关节疼痛是最常报告的症状。139名（报告症状患者中的81.8%）患者表示打算讨论一种症状。在43次（22.6%）就诊中，67种（27.2%）已表达讨论意愿的症状未被提及。在表达讨论意愿后，疲劳和睡眠困难比其他症状更有可能不被提及。在更多身体部位出现的症状中，关节疼痛最有可能不被提及。
本研究表明，症状未被提及的程度在患者、医生和症状之间存在差异。需要进一步研究来探讨未提及症状的后果。
