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Physician Response to “By-the-Way” Syndrome in Primary Care

Journal of General Internal Medicine volume 24, pages 739–741 (2009)Cite this article

ABSTRACT

BACKGROUND/OBJECTIVE

“By-the-way” syndrome, a new problem raised by the patient at an encounter’s closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response.

DESIGN/PARTICIPANTS

Cross-sectional study of 92 videotaped encounters in an academic primary care clinic.

RESULTS

The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient’s question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient’s agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient’s question, particularly (38.5%) if it was of psychosocial content.

CONCLUSIONS

“By-the-way” syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient’s agenda twice or more during the office visit might decrease the appearance of this syndrome.

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Acknowledgments

Funding: the salaries of Pierre-Yves Rodondi and Julia Maillefer for this study were paid by the Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. We thank Dr. Vanessa de Bosset Sulzer for her careful reading of the manuscript.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland

    Pierre-Yves Rodondi MD, Julia Maillefer MA, Francesca Suardi MA, Nicolas Rodondi MD, MAS & Jacques Cornuz MD, MPH

  2. Department of Psychiatry, University of Lausanne, Lausanne, Switzerland

    Marco Vannotti MD

Authors
  1. Pierre-Yves Rodondi MD
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  2. Julia Maillefer MA
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  3. Francesca Suardi MA
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  4. Nicolas Rodondi MD, MAS
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  5. Jacques Cornuz MD, MPH
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  6. Marco Vannotti MD
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Corresponding author

Correspondence to Pierre-Yves Rodondi MD.

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Rodondi, PY., Maillefer, J., Suardi, F. et al. Physician Response to “By-the-Way” Syndrome in Primary Care. J GEN INTERN MED 24, 739–741 (2009). https://doi.org/10.1007/s11606-009-0980-2

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  • DOI: https://doi.org/10.1007/s11606-009-0980-2

KEY WORDS

  • communication skills
  • primary care
  • doctor-patient relationship
  • physician questions
  • psychosocial