Editor—Agreeing the issues that are to be addressed is central to the process of genetic counselling. We undertook a study to document the consultand’s agenda at the genetic clinic and whether the geneticist recognises that agenda. We also addressed whether failure to recognise the agenda is the prime factor when consultands think that issues important to them have been dealt with badly.

Ethical approval was given by the Newcastle and North Tyneside Health Authority Joint Ethics Committee to invite new consultands, over 18 years of age, attending a general genetic clinic to take part in this study. Consultands attending follow up appointments or those who had had a home visit before the hospital appointment were not included. Consultands were given an information sheet with details of the study and a verbal explanation on arrival at the clinic. Those wishing to take part were given a questionnaire to complete in the waiting room before seeing the geneticist. The first question was whether they had asked for the appointment or it had been suggested to them, and the second question asked if they knew the name of the medical condition they had come about. These two questions were followed by a list of issues (table 1) that they might want to address in the consultation. The consultands were asked to mark boxes indicating whether a topic was important, not important, or not applicable to them. There was a space at the end of the questionnaire to add further issues. The study design was based on self completion questionnaires because there are no spare rooms available at the clinics and therefore no privacy for interviews. The benefits of the method are that it is simple and does not intrude unduly on the consultation or the consultand’s time. The major disadvantage is …