The voice of the patient: patients taking the initiative in their interactions with doctors

It seems to be well established in the research literature that patients have difficulty, in their interactions with doctors, in raising matters which concern them, which relate to their agenda. They are constrained particularly by the "interview" format of medical consultations, in which they are restricted to answering doctors' questions. However, in research into doctor-patient communication in both primary and secondary care, including ENT oncology and diabetes clinics, a pattern has been identified associated with patients initiating talk about specific matters which concern them, and which doctors have not asked about; so these are matters which have not been addressed in the consultation up to that point. In this respect patients are "breaking out of" the medical agenda. It seems also that in initiating topics in the way I'll show, patients are resisting doctors' positive or optimistic assessments or prognoses. Therefore doctors’ positive assessments seem not to be congruent with patients' experience; hence patients and doctors as not aligned in their views about "what's wrong".