The first patient appointment begins long before we introduce ourselves. Patients often spend days gathering records, completing forms, reading about symptoms, and contemplating what we might say. As a result, by the time we meet, they may also have formed expectations about how we will respond. They may have read your biography and online reviews, but those descriptions cannot tell them whether you will welcome a difficult question or let them finish an uncomfortable story.
Over the years, I have noticed a guardedness in some new patients. They seem to be assessing whether I will listen, believe them, judge them, or make them feel foolish. A few appear prepared to be scolded. I cannot know what that guardedness means without asking. What are they afraid might happen between us?
In 1983, researchers asked one hundred family practice patients about their worries before a consultation. Their study in the Journal of Family Practice included concerns about explaining symptoms, an impersonal physician, and not being taken seriously. We have evidence that these preliminary concerns exist, but we have less complete information on their frequency, intensity, and relative importance among patients seeing unfamiliar physicians. Today’s practice environment gives us additional reasons to investigate.
For some patients, preparation now happens through a series of portal messages, questionnaires, reminders, and requests for information. Federal health IT data show that nearly two-thirds of individuals accessed an online medical record or patient portal in 2024. That contact creates an opportunity to learn something about the person preparing to meet us. It does not establish that portals cause fear. But I wonder what a patient concludes when we ask extensively about medications, insurance, and symptoms while offering little space for concerns about the encounter itself.
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Online research adds another potential uncertainty. Patients may arrive with information and still feel unsure whether they can discuss it. A 2021 BMJ Open qualitative study found that patients were reluctant to mention internet searches because they feared appearing disrespectful or disrupting the consultation. I would like to know whether a new patient is preparing to hide a question because they expect me to resent its source.
Time is another possible concern. Whatever the scheduled appointment length, someone expecting a hurried encounter may be deciding which symptoms to omit before entering the room. They may worry that bringing a list will seem demanding or that asking for clarification will take time they feel they aren’t entitled to.
Continuity is also an issue here. A 2026 JAMA Health Forum study of traditional Medicare beneficiaries found declining primary care continuity and increasing fragmentation between 2019 and 2023. That finding doesn’t tell us what patients fear, but it makes meeting unfamiliar clinicians especially relevant. A retirement, network change, relocation, or referral can require another introduction. Familiarity with an illness does not necessarily build confidence in the next doctor.
I would add one question before that introduction: “What, if anything, concerns you about how you might be treated?” It could appear in portal intake, on paper, or be offered by staff. Patients should be able to answer in their own words, decline, or say they have no concerns. If someone fears being rushed, we can begin by agreeing on priorities and explaining how we will address remaining concerns. If they anticipate embarrassment during an examination, we can discuss the process before proceeding. If they fear criticism for searching online, I can invite them to share what they found.
I wouldn’t call this a validated screening tool or suggest that it saves time. Its usefulness needs evaluation. Asking also creates an obligation: Someone must read the answer and respond with care. For researchers, the next step is to build on existing work and ask patients before actual first encounters. Let them name their concerns before supplying categories. Distinguish fear from expectation.
For clinicians, the immediate opportunity is more practical. We can acknowledge that preparation for a first visit includes more than assembling a medication list. Before we decide a quiet patient is comfortable, or a guarded patient expects mistreatment, I think we need to hear what they anticipated. Listening to those anticipations will not eliminate every anxiety or solve the systemic constraints of modern practice, but it shifts the starting line of our relationship. By inviting patients to share their worries before we begin, we offer them something rare in an increasingly transactional system: proof that, before we try to treat them, we are ready to understand them.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient-clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
