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Open Access Research article

Open and hidden agendas of "asymptomatic" patients who request check-up exams

Sabina Hunziker1, Martin Schläpfer12, Wolf Langewitz3, Gilbert Kaufmann1, Reto Nüesch14, Edouard Battegay12 and Lukas U Zimmerli12*

Author Affiliations

1 Medical Outpatient Division/Ambulatory Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland

2 Division of Internal Medicine, University Hospital Zürich, Raemistrasse 100, 8091 Zürich, Switzerland

3 Division of Psychosomatic Medicine, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland

4 Division of Infectious Diseases, Hirslanden-Klinik St. Anna, St.-Anna-Strasse 32, 6006 Lucerne, Switzerland

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BMC Family Practice 2011, 12:22  doi:10.1186/1471-2296-12-22

Published: 19 April 2011



Current guidelines for a check-up recommend routine screening not triggered by specific symptoms for some known risk factors and diseases in the general population. Patients' perceptions and expectations regarding a check-up exam may differ from these principles. However, quantitative and qualitative data about the discrepancy between patient- and provider expectations for this type of clinic consultation is lacking.


For a year, we prospectively enrolled 66 patients who explicitly requested a "check-up" at our medical outpatient division. All patients actively denied upon prompting having any symptoms or specific health concerns at the time they made their appointment. All consultations were videotaped and analysed for information about spontaneously mentioned symptoms and reasons for the clinic consultation ("open agendas") and for cues to hidden patient agendas using the Roter interaction analysis system (RIAS).


All patients initially declared to be asymptomatic but this was ultimately the case in only 7 out of 66 patients. The remaining 59 patients spontaneously mentioned a mean of 4.2 ± 3.3 symptoms during their first consultation. In 23 patients a total of 31 hidden agendas were revealed. The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease.


The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues. Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.