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Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study
  1. Dorothee Amelung1,
  2. Katriina L Whitaker1,
  3. Debby Lennard2,
  4. Margaret Ogden2,
  5. Jessica Sheringham3,
  6. Yin Zhou4,
  7. Fiona M Walter4,
  8. Hardeep Singh5,
  9. Charles Vincent6,
  10. Georgia Black3
  1. 1 School of Health Sciences, University of Surrey, Guildford, UK
  2. 2 Public Involvement Programme (People in Research), National Institute for Health and Care Excellence, London, UK
  3. 3 Department of Applied Health Research, University College London, London, UK
  4. 4 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  5. 5 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
  6. 6 Medical Science Division, University of Oxford, Oxford, UK
  1. Correspondence to Dr Katriina L Whitaker, School of Health Sciences, University of Surrey, Guildford, UK; k.whitaker{at}


Background Most cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.

Objective To understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.

Research design Qualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.

Results We found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem’s significance. ‘Disagreements’ may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients’ unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.

Conclusions Our findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.

  • primary care
  • qualitative research
  • patient safety

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • DA and KLW are joint first authors.

  • DA and KLW contributed equally.

  • Contributors All authors (DA, KLW, DL, MO, JS, YZ, FMW, HS, CV and GB) made substantial contributions to the conception and design of this article. KLW and GB conceived the study idea. DA contributed to acquisition of data. DA, KLW and GB contributed to data analysis. All authors contributed to interpretation of the data. DA, KLW and GB drafted the article. All coauthors revised the article critically for important intellectual content and gave final approval of the version submitted.

  • Funding This research was supported by a Cancer Research UK grant (C33872/A24047) awarded to KLW and GB. HS is partially funded by the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN13-413). FW is Director and HS is Associate Director of the multi-institutional CanTest, which is funded by Cancer Research UK (C8640/A23385). YZ is supported by a Wellcome Trust Primary Care Clinician PhD Fellowship (203921/Z/16/Z). GB and JS were supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Bart’s Health NHS Trust (NIHR CLAHRC North Thames). The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical Approval was obtained from London Chelsea Research Ethics Committee (17/LO/0270).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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