Table 2 Facilitators and barriers

Procedural development flaws

- Supporting evidence is not convincing

- Lack of instructions for use

- Guideline developers are not representative of the target group

Assumptive flaws

Erroneous assumptions about patients

- Not all patients are equal negotiating partners.

- Not all patients have a background in Western culture.

- Not all patients present with a new, well defined medical complaint.

- Not all patients come by themselves.

Erroneous assumptions about doctors

- Not all communication is verbal.

- Doctors need to be in charge.

- Experienced doctors communicate differently.

- Doctors want to have the opportunity to express a personal interest in their patients.

- Using the guideline is too energy consuming

Erroneous assumptions about the situation

- Different situations need different approaches.

- The guideline does not support long-term patient management strategies.

Impact on the consultation process

+ More grip on the consultation;

+ More clarity for patients;

- Less focus on the 'here and now'.

Other impact

+ Higher quality of consultations;

+ Does justice to both patient and doctor;

+ Less chance of jumping to conclusions;

+ Fewer unreasonable patients;

- Loss of time;

- Loss of natural interaction and personal style;

- Creating anxiety in patients.