Table 2

Examples of potential impact on timely diagnosis

Negative consequenceVideo dataPatient/doctor interview data
Non-attendance at appointmentsDoctor: (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 doctorDoctor: ‘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 elsewhereDoctor: ‘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)