Teaching students of medicine to listen: the missed diagnosis from a hidden agenda.

This paper describes the ability of 4 senior students to recognize and deal therapeutically with the hidden agenda of patients--the covert concerns or second diagnosis other than the presenting problem. This naturalistic study was hospital-based and used ambulatory patients with common paediatric problems. The patient encounter was videotaped and subsequently analysed to determine the patient's hidden agenda. The findings indicated that the students had some difficulty in correctly diagnosing the patient's presenting problem or primary diagnosis. They also failed to recognize and deal with their patients'/parents' hidden agendas. The relevance of these findings to patients care is discussed.