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D: doctor P: patient ? rising intonation . a stop indicates the micro-interval between segments of speech (.) a stop in round brackets indicates a pause of less than one second (2) a number in round brackets indicates a pause timed to the nearest second :: a colon indicates lengthening of a sound with additional colons indicating further lengthening no underlining indicates a word spoken louder than those around it pres- a dash immediately after an item indicates that the speaker has broken off before completing the utterance [ square brackets on successive lines indicate the beginning of simultaneous [ speech = = equals signs indicate that there is no interval between adjacent utterances {mhm} curly brackets enclose brief utterances made during another speaker's turn, which show acknowledgement of what is being said ((sighs)) text in round brackets indicates either contextual information or non-verbal vocalisations (?guess) text in round brackets preceded by a question mark indicates an educated guess hh/ha indicate units of laughter 1 P: hello? 2 D: hello . it's Dr Macintyre here from the health centre . I got a message to phone 3 4 P: oh right . yeah . who . who's this? 5 D: about Leslie Kirkness 6 P: yes . that's right . aye 7 (1) 8 D: it's Dr Macintyre here 9 P: right . e:rm . what it is is . I've just come back from holiday this morning 10 11 (.) 12 D: aha 13 P: and . my ankle . from m- . well ((several words unclear)) for another reason is . is really swollen up 14 15 D: aha 16 P: and . I seem to have . the . the . the (?likes) o'mosquito bites and everything 17 18 D: aha 19 P: but it is really swollen and pretty painful 20 D: and where were you on holiday? 21 P: erm . we were in Greece . e- in . er . an island 22 D: right 23 (.) 24 D: and it's just the one ankle that's swollen? 25 P: yes 26 D: right 27 P: it's just when I got off the plane it . it really . it was throbbing a bit and . I noticed it was swollen 28 29 D: aha 30 (.) 31 P: I thought I'd better just find out what's wrong wi'it 32 (1) 33 D: yeah . well . I think probably we want to have a look at that . erm 34 ((inbreath)) right . if we (.) if I get you to come down at erm . 35 eleven fifty? 36 (.) 37 P: yes . that sounds [alright 38 D: [is that okay? . and er we'll have a look at you 39 then . not giving you very long is it . I'm giving you five minutes . 40 right . will you pop down in about five minutes 41 P: yeah . I'll just come across then . [(?doctor who? 42 D: [okay . that's great 43 P: Dr Macintyre? . eh 44 D: it's Dr Darwin 45 P: Darwin . [right . okay 46 D: [okay . right 47 P: right . fine . bye Example Face-to-face consultation, n (%) Telephone consultation, n (%) Doctors make direct enquiries “Example 24 (75) 17 (52) D: come in (4) P: hi D: have a seat (4) D: well (.) what can we do for you? P: well (.) you know I was up here before . I had the Morton's neuroma Doctors give indirect signals Example 3 (9) 10 (30) P: hello D: hello . it's Dr Macintyre here from the health centre P: [oh yes D: [got a message to pho:ne Olivia McDonald P: right . aye . it's . it's for my daughter . she's e:m (.) I spoke to the health visitor this morning [she suggested I speak to you D: [oh right D: aha P: em . she had a wee eye infection Patients initiate disclosure Example 5 (16) 4 (12) P: hello? D: hello: . Mrs Haston? P: oh hello do[ctor Devine D: [hi there P: [thank you for calling me back D: [hi there D: [no problems P: [((inbreath)) . e- . I'm just wondering if you've had any: more progress in . in . erm (.) you know . in in . [in getting me the: patches for the Lide . D: [about the patches P: Lidocaine patches Doctors give test results Example – 2 (6) ((opening missing)) D: whether or not you would mind if we record . the conversation P: no probl[em D: [is that alright with yo[u? P: [ye:s D: is that alright? . [(alri(h)ght hh hh hh hh) P: [(?that's oka:y) D: well . having done that then . I . I just wanted to catch up with you . two things really . cos your bloods results are back P: right D: I was pleased with them all really Total 32 33 Example Face-to-face consultation, n (%) Telephone consultation, n (%) Patient discloses additional concern in response to additional enquiry by doctor after first problem has been dealt with Example 7 (28) 1 (20) D: [we'll just leave your medicines as they are P: [well I thought I'd better let you see D: so that's okay . and what's happened with your neuroma then? (.) P: well . it's fine Patient announces two concerns in response to opening enquiry by doctor and additional concern is reintroduced by doctor or patient after first problem has been dealt with Example 6 (24) – D: what can I do for you? P: ahm . basically ahm . just wanted to come in for a check-up and I'm also on the last packet of my Microgynon pill Patient discloses additional concern after first concern has been dealt with Example 12 (48) 4 (80) D: with anything like this . keep an eye on it if there's changes happening there in the skin or on the foot (1) D: or it's changing just . or anything that happens elsewhere in the body for example let's have another look at it (2) P: that's . really got nothing to do with it . see that wee bump there? D: yeah P: I've had that for about 4 years Total 25 5 D: and is the e:ye itself red or anything? (1) P: e:m . no D: no D: okay . so I- you- you're not taking ibuprofen now and you've had no chest pains since you . er . stopped the . omeprazole P: nope D: fine . Example Face-to-face consultation, n Telephone consultation, n Follow-up arrangements only Example 19 16 D: right . so . I'll leave a prescription at the desk? P: right (.) D: and . shall we: . talk this whole thing through again: . what? . late September? P: right . okay Follow-up arrangements and safety-net advice Example – 5 D: yeah . I mean . th- . th- then I would probably say y- . you know . that it . you know . getting a stool sample kind of and probably having a wee look there as well would be worthwhile . just having a feel of her tummy and things like that but . (unclear) very much on how she is in herself and if there's any concerns particularly with . you know . any acute pain P: yes D: anything abnormal in the stool . [any blood or mucus or P: [right D: anyth[ing like that . and . any . if there's any problems P: [aha D: with her drinking . you know . any kind of dehydration . obviously you need to get back in touch with us Safety-net advice Example 10 5 D: well . we'll just . go with that . I don't think you'll need antibiotics . [eh (unclear) P: [alright . should I put Sudocrem on it just to D: yeah . that would be fine . [I was gonna say see how it is P: [yeah cos D: over the next twenty four [or forty eight hours . if you P: [right D: think it's recollecting or you think there's more problems with it . then please please please speak . eh . back to me Example Face-to-face consultation, n Telephone consultation, n Closing of reason for attendance stage (a) Patient initiates closing by restating problem Example 29 25 P: so . em . I just wondered rather than . come in hh em . if you could write a prescription for anything? D: mm yea:h . I'm sure we can . I'm sure we can . w-what sorta what way are they . the:y . bothering you. Fiona? (b) Patient initiates closing by falling silent Example 17 6 D: (inbreath) now . you said there's something else as well? P: aye D: aha P: the- . p- . it's been swelling up (1) D: right . is that your left leg? (face-to-face consultation)) Closing of verbal/physical examination stage (a) Doctor initiates closing by giving decision Example 38 19 P: (patient responds to doctor's question) but . I don't have any problems D: right . no . well that's fine . well . it's . it's . if you are still . if you're still having a regular . bleed P: mh[m D: [the chances are you are still ovulating so P: right . [right D: [you still need protection [(unclear) (b) Patient initiates closing by restating problem Example – 6 P: so I was just ringing up to see if I actually needed to be seen or if I needed a . a course of [antibiotics or what D: [we::ll . same story of like a boil anywhere in the body Closing of decision-making stage (a) Doctor initiates closing by repeating advice and checking Example 29 32 D: [I kno:w . but I think . cos the other one's specifically for your skin so ((repeats advice)) see what's going on . but P: ye:s D: is that . is that oka:y? P: yeah . oh that sounds fine (?doctor) (b) Patient initiates closing by restating arrangements Example 3 1 D: yeah . [yes P: [yeah we had two or three holidays there . it's beautiful . e:rm . so I'll come back and see you a week on Tuesday D: yes . and we'll . we'll go through the x-ray and [see what it [shows P: [right [see what it impl[ies D: [yeah Example Face-to-face, n Telephone, n Doctor closes subtopic Example 39 9 P: and he said ehm (.) ‘so what happened this time?’ . I says ‘somebody was up against my door again’. [I D: [yeah . yeah P: I says ‘I I I . I can't live like this’ D: no P: you know I [can't . i- . it D: [how long has it been going on for? P: sin- since I moved in D: which was . how long ago now? Patient closes subtopic Example 50 9 D: the pill won't . e:r . affect that [specifically P: [right D: so you'll kn[ow in that sense when P: [okay . so all is . all is . fine at the moment [then D: [yeah . yeah P: right (Doctor completes examination and the patient explains how leg pain is reducing her independence) (7) P: see I don't like to hang about and and (.) just do nothing . I dinnae like everybody to do anything for me . I like to do wee things for myself {D: mhm} like going to the shops and that . but it's getting now that I'm even feared to go to the shops (2) D: well I think we'll get some nice . support stockings for you (Elderly patient is having a check-up) D: so what've you got planned at the moment then? . are you? P: we're home for a bit now . we've just been away in the caravan D: right . [did you . go to the s- P: [we were away in May D: s:outh west was it? P: tha- . yea- . no the south east . we went to Kent= D: =south east . right
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British Journal of General Practice
Comparison of face-to-face and telephone consultations in primary care: qualitative analysis
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