Influence of family/friend
Many participants described being prompted by a family member or friend to seek advice from the GP. Some family/friends were said to be more concerned than the participant about their illness. Some participants sought advice from specific acquaintances if they were employed in the healthcare sector:
‘She just looked at me and said, “Oh Mum, you really are poorly, have you phoned the doctor?” and I said, “No,” I said, “I thought I might leave it until tomorrow.” She said, “No, I think you ought to phone the doctor now”, and I did.’
(P16, F, aged 70–74 years, RTI)
Some participants identified that others may be able to better recognise illness than they were themselves. Their ability to notice deviation from the norm was also acknowledged by some of the participating carers:
‘Because she [daughter] can see it whereas I can’t. It’s so gradual, I don’t take any notice and every time she does that, I ends up in hospital.’
(P8, F, aged 70–74 years, RTI)
‘I know what normal is. If it deviates from normal, then, you know, you ought to get Dad some assistance to try and help him.’
(M carer of P18, M, aged 80–84 years, UTI)
Tipping points
Most participants recognised at some point during their illness that they needed to seek professional help; however, this was balanced against the desire not to be a burden on the healthcare service or risk wasting a doctor’s time:
‘But it is, they’re very busy people and you don’t want to be one always turning up and are you really ill or not, you know. It’s very tricky to decide for yourself if you’re really ill.’
(P13, F, aged 75–79 years, RTI)
Some participants (both patients and carers) cited specific symptoms as their reason for seeking help. These were either extreme or intolerable, a visible marker that something was wrong or something that they had previously experienced or had been told to act on:
‘I always know when he sort of goes a bit grey and he’s gasping for his breath and he just can’t get his breath. That’s when I know to get help.’
(F carer of P12, M, aged 80–84 years, chest infection)
Some participants described self-monitoring some of their vital signs and using measurements as a prompt for seeking help. In particular, some participants with chronic lung disease had an oxygen saturation probe for use at home. One participant had been advised to do this and been given thresholds by his secondary care team:
‘I monitor my sats [peripheral oxygen saturation], blood pressure. Blood pressure was all right but the sats were dropping. Normally, I’ve checked back through my records and it’s 96/97/98 and it was down 90. I think when I went to see the doctor it was 91.’
(P11, M, aged 70–74 years, RTI)
Another participant purchased an oxygen saturation probe after experiencing an infection because of the concern expressed by his GP at the time of his examination. This participant hoped it would prompt him to seek help earlier in the future.
Some participants described waiting for a certain length of time to see if their illness would get better without any professional input. The delay ranged from a few hours to a few weeks, and this was frequently influenced by previous experience of infection or modified by any symptom progression. In particular, symptoms that worsened after an initial period of improvement were a prompt to seek advice:
‘So, I sort of got to a stage where I was sort of saying 90% better and then that, that was, that stayed at that level and then suddenly it started to go back down again.’
(P11, M, aged 70–74 years, RTI)
Reasons cited by participants for the delay in seeking healthcare advice included the belief that they were already getting better, the belief that the illness would get better at some point, the belief that they could manage their infection themselves, or not wanting to bother healthcare professionals. In hindsight for several participants, including carers, the delay was a source of regret:
‘I think based on what I’ve been through, and as I say, going back and looking, I wouldn’t have left it so long because I virtually went for a week, you know. I wouldn’t have left it so long before actually went to a doctor.’
(P22, F, aged 70–74 years, abscess)
‘I mean we, we thought he was all right ‘cos he could struggle about. And I think I was wrong ‘cos I didn’t do anything. I just, he just went back to bed.’
(F carer of P5, M, aged 75–79 years, cellulitis)
Some participants described seeking help only when they or their care network were no longer able to manage a certain symptom themselves and/or when self-initiated treatments had failed (including homely remedies, nebulised therapy, and rescue antibiotics/steroids):
‘I try, if I’ve got antibiotics and steroids I’ll go on them which I didn’t have this last time. That’s why I had, had to see the doctor. But normally I just carry on and get on with it.’
(P8, F, aged 70–74 years, RTI)
Having previously experienced an infection (as described in the ‘Previous experience’ section under ‘Theme 2: Interpreting symptoms’) gave participants a reference point to know when things were no longer manageable.