How well do physician and patient visit priorities align?

Purpose ▶ We undertook this study to explore the factors associated with differences between patients' stated main reasons for outpatient visits and physicians' main concerns at those same visits. Methods ▶ This cross-sectional, mixed-methods study examined 192 outpatient visits with 4 physicians at 4 diverse primary care practices. During each visit, participating physicians elicited the patient's main reason for the visit. Immediately after each visit, physicians documented 1) their understanding of the patient's stated reason and 2) their main concern for the patient during that visit, and 3) assessed the extent of their alignment with the patient's reason for visit. We assessed bivariate and multivariable associations of patient and visit characteristics with alignment, and further examined cases with unaligned physicianpatient priorities to identify patterns. Results ▶ In 69% of visits, the patient's stated reason for the visit was completely aligned with the physician's main concern. In 12% of visits, we observed totally unaligned priorities; 19% were only partially aligned. Uninsured or publicly-insured patients and visits with more problems addressed were less likely to be fully aligned. In many visits with unaligned priorities, patients' stated reason for the visit was a self-limiting, symptomatic concern while physicians prioritized potentially dangerous asymptomatic conditions or ill-managed chronic conditions. Conclusions ▶ In diverse family medicine practices, lack of alignment between physician and patient visit priorities reflects differing prioritization processes. Patients presenting with concerns unaligned with their physician's priorities may require more time or different approaches to ensure the relevance and patient-centeredness of their care. These findings may inform the design of systems of care that promote mindful attention to patients' priorities while addressing medically urgent or preventive services delivery.