“What Else?” Setting the Agenda for the Clinical Interview

Let's consider this all too-common ending of a medical interview:

Dr. A.: Well, Ms. X., it looks like that head stuffiness is just a bad virus cold and not a bacterial sinus infection, so I think we're going to have to wait it out. Antibiotics don't help with viruses and really could cause more trouble, so I don't think we'll need them.

(He stands and moves to the door, his hand on the doorknob.)

So I'm glad it wasn't anything worse. Let me know if it seems to be hanging around more than another week or if anything else develops.

Patient: Yes, thanks, Doctor. But before you go, there is one other thing.

Dr. A.: Yes?

Patient: Well, it's just that I've been having blood in my bowel movements. It isn't all the time, but sometimes the bowel movement is mixed with a lot of blood and I was just wondering if I should do anything about it.

Dr. A.: I don't believe it. Really?

Patient: Yes. Why? Is it something serious?

Dr. A.: Well, yes, it could be. And I wish you had mentioned it before. Why didn't you tell me before?

Patient: You didn't ask me.

In the United States, this frustrating interaction is usually called the “Oh, by the way, Doctor” interview syndrome, or the “doorknob question” because the doctor frequently is on her way out the door, hand on the doorknob, when the question arises. The French often call it the à propos, Docteur” question; the Dutch may call it tussen haakjes (“between 2 brackets” or, as we might say, “parenthetically”); and Barcelona physicians suggest that it is another case of puayque, eliding the patient's “Pues, ya que estoy aquí…” (“Well, since I am still here…”). Observers note that the syndrome …