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Table 2 Examples of the absence of a dialogue

From: Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study

GP: Right. I hear things aren’t going so well?
P: No
GP: No?
P: Not at all. I phoned the GP out-of-hours surgery yesterday, actually. I got so short of breath I almost suffocated.
GP: Right.
P: So I don’t really trust the situation, to be honest.
GP: Right, right, so where do you get that feeling that...?
P: Here.
GP: And do you feel feverish too? Do you feel sick a s well?
P: My temperature went up but it’s gone back down. It’s just that I don’t have any energy.
GP: OK, right.
P: And sometimes I feel dizzy.
GP: But I understand you’ve had these complaints for some time? Because if I look back a bit, you’ve had these complaints for several weeks.
P: Yes.
GP: Right.
P: But not as bad as now.
GP: So has it got much worse recently?
P: Yes. Starting yesterday. And today it’s even worse.
GP: Can you hear yourself wheezing too?
P: No.
GP: How do you find swallowing?
P: Difficult.
GP: Difficult. You don’t find yourself drooling?
P: No, I don’t do that.
GP: No. You’re still eating and drinking?
P: Yes, though I find it difficult.
GP: Are you still taking something for the pain?
P: But I don’t feel any pain – it’s just suffocating.
GP: Do you feel as though you’ve got a lump in your throat?
P: Yes.
Quote GP:
“I think I’d have been better off asking about the purpose of the consultation because I can see that now I immediately start asking very specific questions about the complaints. Then I’m really focusing much too much on the complaints again rather than trying to find out what she wants help with.”
Quote patient:
“Yes, I felt irritated because I had this feeling that the doctor wasn’t taking me seriously. I just didn’t feel I was being taken seriously. The GP should have discussed my question sooner and that rather gave the game away. The GP didn’t do that.”
GP: How are you physically, apart from that?
P: Yeah, that’s fine.
GP: But …?
P: Except I was here a while back too for my stomach pain.
GP: Right.
P: And I had real problems yesterday and today with cramp. That was really painful cramp, you know.
GP: Because you’ve been to hospital, right?
P: Yes, but it was nothing. Fortunately they couldn’t find anything.
GP: Nothing. So what is it, then?
P: But that day I... I felt really terrible and I couldn’t even get up because of the pain. I was in an awful lot of pain then.
GP: Right, exactly.
P: But now it’s more like, I don’t know what it was, what do you call that? Because I used sachets and they didn’t help.
GP: No.
P: And I have this feeling that my stomach is clogged up or something because I’m also getting a lot of wind and nasty cramps.
GP: Right.
P: Yeah, incredibly painful cramps. And I’m also feeling sick, so it has been really bad today and yesterday.
GP: Exactly. OK.
P: So, there you have it.
GP: Something new came on the market recently.
P: Really?
GP: Yes. It works on the basis of peppermint oil and it’s very much for irritable bowels like you have, so perhaps that’s something you could try. You haven’t taken it yet and it has only been around for a few months.
Quote GP
Of course, I take things much too quickly again with her, in the sense that I don’t explore things properly. That’s because I see her so often. She’s one of the patients who has been to the surgery most often since I’ve had the practice. I’ve seen her at least thirty times in the past 3 years. But yes, I take things too quickly here”.
Quote patient:
“Then the doctor usually says it’s all in the mind; that’s happened a few times. Now I get the feeling he just takes a quick look. Yes, it’s you again … then quickly shows me the door. Then I don’t feel I’m being taken seriously”.