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Preprints.org
By Sompur Vasanthkumar SK.
Patients frequently leave consultations with concerns, expectations and questions they never voice. This “hidden agenda” carries particular weight in psychiatry, where stigma, power asymmetry, fear of coercion and the illness itself may suppress disclosure.
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This narrative review synthesised conversation-analytic, observational, qualitative and interventional studies, systematic reviews and meta-analyses on agenda-setting, patient expectations, question-asking, shared decision-making and communication in medical and psychiatric consultations. Seminal and replicated findings were prioritised, and reporting followed the SANRA criteria for narrative reviews.
Clinicians often fail to elicit or complete the patient’s agenda, interrupting opening statements within seconds. Unvoiced concerns underlie misunderstandings, unwanted prescriptions, non-adherence and dissatisfaction. In psychiatric settings, many patients ask no questions, patients with psychosis struggle to raise the content of their experiences, and suicidal ideation is concealed chiefly for fear of involuntary hospitalisation. Barriers operate at interactional, psychological, sociocultural and illness-specific levels, and may be amplified in Indian practice by brief consultations and family-mediated decision-making. Clinician agenda-setting skills, question prompt lists, pre-consultation coaching and shared decision-making programmes adapted for severe mental illness measurably increase patient participation.
The questions patients do not ask are often those that most need answers. Eliciting and negotiating the hidden agenda should be regarded as a core, teachable competency of psychiatric practice, supported by communication training, patient preparation tools and consultation structures that make unspoken concerns speakable.
This is a preprint: it has not been peer reviewed yet, and its findings may change.
Published in Preprints.org (preprint). The abstract is shown as published and remains the work of its authors; read the full article at the source.
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