When time constraints are visible
When discussing their reservations about seeking help for cancer ‘alarm’ symptoms, participants made frequent reference to the time constraints incurred by GPs. Reference was made to increasing duties on GPs alongside their medical responsibilities such as ... ‘all the … paperwork they have got to do and the money juggling that the government is forcing on them’. (P18, M, 50 years; change in bowel habits, rectal bleeding)
Participants were understanding of GPs and how ‘... they are not going to have time to do this, that, and the other. It’s the system.’ (P29, F, 83 years; changes in the appearance of a mole), and mentioned how this made them ‘... reluctant to be knocking on the GP’s door all the time because we know how busy they are.’ (P21, F, 67 years; change in bowel habits, abdominal bloating, change in the appearance of a mole).
The perception of GPs’ lack of time was derived in particular from waiting times at the practice and difficulty making an appointment: ‘They have got a hard enough job as it is. As I say, you’ve got to wait a week for an appointment anyway.’ (P22, M, 68 years; persistent cough or hoarseness)
Furthermore, negative interactions where participants were left with the impression that they were ‘crying wolf too much’ (P11, M, 69 years; change in bowel habits) made participants feel as though they were wasting their GP’s time. At times, this made help-seeking humiliating and made some feel as though GPs ‘are just not interested’ (P54, F, age missing; persistent unexplained pain): ‘Well, it was just so overwhelmingly humiliating, the fact that I went in and said, “Please can you do something with this?” And he literally turned round and said, “Why are you bothering me with something as trivial as that?”’ (P24, F, 64 years; persistent cough or hoarseness)
Although negative experiences with GPs led some to feel bad about help-seeking, others reported how positive GP interactions reduced their worries about wasting time, pointing out that the GP ‘doesn’t make you feel that you’re a nuisance.’ (P20, M, 67 years; persistent cough or hoarseness)
Some conveyed a need to avoid being perceived as a hypochondriac when returning with a symptom. They expressed how they did not want to bother the doctor: ‘I do feel as though I am … not annoying them, but “oh not you again”, sort of thing.’ (P62, M, 62 years; persistent unexplained pain, abdominal bloating)
In some cases, such contemplation occurred despite acknowledging that they did not know how the doctor felt or claiming that they were ‘not scared of what he [GP] might think of me, exactly, but I don’t want to bother him.’ (P36, F, 72 years; sore that does not heal, persistent unexplained pain)
Participants mentioned that: ‘It’s quite important to respect the fact they have these very limited appointments now. So I try not to take advantage of that and mention anything else.’ (P42, F, age missing; change in bowel habits, persistent cough or hoarseness)
Thus, to avoid wasting GP time, participants not only held back information so that they would not compromise their GP’s appointment structure, but some also felt they had to be apologetic if they did not stick to the ‘one item per visit’ rule or the 10-minute time slot. One participant said he would: ‘rehearse what you are going to tell the doctor, because I’m very, very conscious of they’ve only got so much time for each patient.’ (P53, M, 58 years; unexplained lump)
When symptoms are perceived as not serious enough
Some participants felt that seeking help for symptoms that were not serious enough would result in wasting GP time. Reference was made to symptom characteristics, such as whether they were life-threatening, treatable, or chronic. Some said they ‘... wouldn’t want to go and see them [GP] with something which was trivial’ (P5, M, 62 years; sore that does not heal) or ‘It’s got to be life-threatening, and that requires investigations.’ (P22, M, 68 years; persistent cough or hoarseness)
Some described withholding information about less serious symptoms, believing they would otherwise waste their GP’s time. For example, they made reference to not wanting to: ‘... bother the GP with all my symptoms every time, just what I think is pertinent’. (P19, F, 67 years; unexplained weight loss, persistent cough or hoarseness)
Where long waiting times existed, there appeared to be a link between awareness of GP time constraints, symptom seriousness, and the worry of wasting GP time, and potentially benign symptoms increased worry over wasting GP time. Some participants felt that: ‘... the longer the waiting list, the more urgent I think it needs to be in order to go.’ (P9, M, 63 years; change in bladder habits, sore that does not heal)
Many participants only felt comfortable seeking help for symptoms that were ‘worsening’ or ‘persistent’, as these characteristics were seen to reduce the likelihood of going unnecessarily. Although ‘persistent’, symptoms could also be problematic because people do not want to go back unless ‘you are in really dire pain.’ (P37, F, 88 years; unexplained weight loss, change in bladder habits, persistent cough or hoarseness, abdominal bloating)
Symptom characteristics also contributed to how individuals compared their symptoms or situation to hypothetical others who may be in more urgent need of medical attention. Taking hypothetical others into account increased their worry of wasting their GP’s time. Some felt uncomfortable ‘... bothering the doctor, they have got people who are much more seriously ill to see to than I.’ (P10, M, 77 years; abdominal bloating, persistent cough or hoarseness), and that ‘... other people have more serious things wrong. My things are just trivial.’ (P17, M, 62 years, change in bladder habits)
When an alternative healthcare practitioner could provide a diagnosis or treatment
Participants felt that sometimes an alternative healthcare practitioner, such as a nurse, a pharmacist, or even self-medication, could provide a diagnosis or treatment, and that GP time was wasted were these alternative sources of medical attention not sought before a visit to the GP. Going to the pharmacy or self-medicating was a way for participants to ‘cope with it elsewhere’ (P27, M, 62 years; difficulty swallowing) and to ‘take care of this myself.’ (P19, F, 67 years; unexplained weight loss, persistent cough or hoarseness)
Nurse practitioners were seen as ‘quite useful for going along with something that you just want reassurance about.’ (P40, F, age missing; change in bladder habits, difficulty swallowing, persistent cough or hoarseness, rectal bleeding)
Reference was made to how participants felt pressured during GP appointments compared with feeling at ease with a nurse. Participants would categorise their symptoms and reasons for a healthcare visit. If symptoms were not serious, and if the outcome sought was reassurance, then visiting a nurse or pharmacist was considered appropriate.
