Examples of situations alerting the doctor to a hidden agenda are given by Freeling and Harris (1984). Nonverbal cues may be obtained from the patient’s gestures, posture and dress, reflecting an emotional state she or he does not mention. Or the patient’s opening gambit may be a general question rather than a statement about the problem. If the doctor suspects a hidden agenda is present, he may want to prompt the patient gently: ‘Is there something else you wanted to tell me?’ Otherwise it may come out as a throw-away line as the patient is leaving – the ‘by the way’ syndrome.
Janice, a 26-year-old insulin-dependent diabetic came in to see her GP whom she had known for four years. She was requesting lancets for blood glucose monitoring. On receipt of the prescription she asked if it was possible for her to be referred to a clinic where sexual problems could be discussed. When asked what the problem was she hastily stressed it was her problem, not her husband’s, and that she had a block when making love.