Examples of potential impact on timely diagnosis
| Negative consequence | Video data | Patient/doctor interview data |
| Non-attendance at appointments | Doctor: (While studying pictures of moles at computer screen to compare them with the patient’s mole): ‘So yours is a bit like that (pointing at a specific picture) but it’s with the good contrast is….and the fact they’ve changed a bit’ Patient: ‘I’ve had them for years.’ Doctor (still looking at computer screen): ‘Mhm. It’s just a bit like that one there.’ Patient: ‘Mhm.’ Doctor: ‘… you’ve got to be so careful because…the amount of …which is the one we’re worried about is similar ehm. I wonder it’s the safest thing to do, would be, to refer you to see a skin specialist.’ (doctor looking at patient now) Patient: ‘Mhmh, okay.’ Doctor: ‘Ehm, and if we think it could be (short pause) melanoma (gesturing with his hands), which I’m 99.9% sure it isn’t if we do think it could be, we would have to refer you to under what is called the 2 week rule’ Patient: ‘As you what you did for my …throat’ (gesturing towards her throat) Doctor: (nodding in her direction) ‘Yeah.’ (…) | ‘I can’t really afford to be ill, as I say, my husband’s in a care home and I see him every day and he has quite a few medical conditions which means that I can’t afford to have any.’ (Patient) ‘Interestingly, looking at her notes, she never kept the appointment to the skin specialist that I can tell, so that is rather odd, that is rather odd.(…)Bear in mind also she was brave enough to come and see me so I suppose you’d have thought she would have kept that appointment but there is no letter back from the hospital at all so I’m assuming she never went.’ (Doctor) |
| Loss of trust in doctor | Doctor: ‘Ehm. So it could just be a little inf…cyst that’s in the area (Patient: “Yeah.”) cause where it’s red and tender, that is more likely to just be a little bit of maybe an infection that’s there.’ Patient: ‘Yeah.’ and puts the necklace with her glasses back on. Doctor: ‘Ehm but with anything where there is a breast and there is a lump (again pointing towards her breast with her right hand to emphasise) we do want to be completely sure it’s not anything sinister in any way’ (nods a few times in emphasis) (Consultation GPWD59) | ‘She did look at it and she just then referred me to the Breast Clinic, which I didn't feel I needed, I felt it was just an abscess or something(…)I ended up having surgery which I feel I didn't need to have.(…)So that's how I feel and I feel the whole experience was terrible.(…)She just said 'oh yes, but we'll send you to the Breast Clinic', that's it,(…)she thought it was probably only a little cyst or an abscess, but she said it's best off to go there. Why, I don't know.(…)It was so red and so angry it must have come to her 'ooh, that's not a cancerous lump' or something, I don't know, unless she thought it was.(…)And I've never seen Dr(doctor’s name)before and I don't wish to see her again at the surgery, so that's how I feel about her.’ (Patient) |
| Decision to seek help elsewhere | Doctor: ‘Is it falling out or just not growing well?’ Patient: ‘Well it’s a bit of both, it’s a little bit for, you know, you know when you comb your hair, it just seems more than usual, I’m not sure how I can measure that, but it just seems…’ Doctor: ‘Ok yeah.’ (…) Patient: ‘But it’s also not growing- not growing at all.’ Doctor: ‘But generally speaking there’s no bald patches or anything like that.’ Patient: ‘No, I don’t think so.’ Doctor: ‘Other than that it’s pretty…’ Patient: ‘No I don’t think I’ve noticed any bald patches… because I was just wondered whether it’s any sort of, I don’t know, infection, that’s’ that’s what…you know?’ Doctor: ‘Let me just check your blood pressure and have a look at the back of your head…’ (Consultation GPXM228) | ‘I didn’t actually feel the doctor really understood what the issue was for me, and I think because there was no examination I just left feeling well, that was a bit of a waste of time.(…)I wasn’t particularly impressed in terms of the consultation and the communication because I don’t think he fully understood the impact you now, everything was having on me really(…)I’ve totally given up on the doctor because I don’t think they understand at all, so I’m actually going to, what am I going, I’m going to see, what have they got, a trichologist we’ve got someone who deals with health, hair and scalp.’ (Patient) |