Table 4.

Comparison of ‘symptoms of concern’ and ‘symptoms as normal processes’ accounts

	Symptoms of concern/disease accounts	Symptoms as normal processes accounts
P6
	LR:...how [do] you think it all sort of started? P6:...we went merrily on our holiday, and the cough just got worse and worse and worse. Coughing 24 hours a day the whole of the five days we were away...I went to see a doctor [who prescribed antibiotics]...the antibiotics didn't touch it at all, so when we came back, I went to see one of my own doctors and he said ‘you've probably got a chest infection. I'll give you some more antibiotics’...‘if at the end of seven days it hasn't gone, then I think you'd better go and get an x-ray’.	LR: OK. So cough, we've done. Breathlessness? P6: …That [the pacemaker] cured it...so at the moment I'm just left with the cough or whatever... LR: So the only times you get breathless really are then when you're coughing? P6: Yeah. LR: Do you notice (.) is there any other time now P6: Occasionally I get breathless walking up hill, but that's to be expected. P6P: And you did a bit Friday which was stress I think. P6: Yeah, Friday…It does occasionally happen when I'm sitting down...Up to recently I've been playing golf twice a week, so there can't be an awful lot wrong with me, but I do get occasionally short of breath…Just suddenly start breathing rather rapidly
P12
	LB: Do you want to just tell me how you came to be in Mr [ ] clinic and what were the events that P12:  yes. I had a particularly persistent cough that wouldn't go away...although it was literally just a sort of a clearing the throat, that sort of thing...[then] I woke in the middle of the night with a cough, my mouth filled with what I thought was catarrh, went to the basin, spat it out (.) blood bright red and dark red. And it bled for about 10 or 15 minutes...and it hasn't bled since...Anyway, Monday...went to see GP...immediately gave me the ticket to go to the walk in x-ray[ ]	LB: Have you lost any weight at all? P12: A bit, mm. I would say less than half a stone P12P: We have a very active cruise, we do a lot of walking and sightseeing... P12: And then you know, we go to [UK holiday destination] most years. And we walk a tremendous amount. And I swim a lot there, don't I? So that's a very active holiday.
P16
	P16: I developed a cough and also that I didn't feel very well and I'd also lost some weight. I went to the doctors... [s/he] sent me for a blood test and an x-ray. And several days later [s/he] rang and said I want to see you and by this time I'd got my appetite back and my weight had come back up again...	P16 : I think perhaps if it had just been a cough, perhaps I wouldn't have bothered … P16P: … after you were feeling better, you'd put weight back on and you'd still got this funny cough, I think you could have gone on for months with that funny cough .[ ].. P16: LR: have you experienced any breathlessness at all? ((pause)) Or sort of thing like you P16:  I play golf and parts of the course are a bit steep and I must admit I get a bit puffed going up there but yeah it's not serious I just got to take it easy… as you get older so you can't do the things you did when you were a bit younger so...quite often you put things down to change of your age and lifestyle and it wasn't that significant...I really wouldn't say I get breathless, I mean you [participant's wife] couldn't keep up with me.
P23
	P23: and then we got to Christmas, and we were partying etc and to be quite honest, I should have put on more weight than I did. So I started to think ‘well what's going on?’ About [ ] months ago I had a colonoscopy and had a few polyps removed etc...I started to get night sweats, totally different from hot flushes...so I thought ‘oooh this is a bit odd’.	LB: Have you suffered from any backache or shoulder ache? P23: No. LB: Anything that you thought might be something else wrong? P23: I've had perhaps the odd twinge [in fingers] that I would put down to arthritis while doing the garden or something but—this is the annoying fact, I am quite healthy; well I think I'm quite healthy, and so no I wouldn't say I've had aches and pains.
P24
	P24: I started coughing up blood and I was already at Dr [ ]s clinic and when I told [ her ] I was coughing up blood, s/he referred me to the chest clinic which is next to Oncology, so that made me feel a bit suspicious...By that time I was admitted to hospital because I was coughing up what I thought was a lot of blood, and I had a lot of problem breathing...Dr [ ] came over to see...and he changed my inhalers and took me off beta blockers and transformed my life!	LB:...when you were having breathing problems, did you ever have any wheezing with it? P24: Oh I do wheeze a bit in bed now. It's just you get used to the noises that your chest makes don't you really? I just think ‘oh shut up’. I mean I do sleep very, very well unless I'm depressed...Sometimes just when I lie down I'll wheeze a bit and that's obviously changing from upright position to lying down but and not to any extent.
Incidental Diagnosis
P3		LR: Er, so have you had any weight loss at all? P3: Yes. The lady [ ] that dances with me, she's been making off for months now that I'm losing weight. LR: Yeah? P3: Yeah. So I expect to lose weight in the summer months because you're more active over the allotments. .. plus the days are longer so you spend longer away from home so you don't eat so much, but I used to be [ ] stone, but when she weighed me yesterday with my clothes on, she said I was [1.5 stones less] LR:...you think that's just over the summer or ? P3: I reckon that's over the last 2 years. LR: Yeah? RES: Yeah. I reckon about the last 2 years, because I always said [1.5 stone heavier than current weight ] stones is too heavy for me. And then people would say it's a beer gut
P28		LB: Have you had any other types of cough that have lasted more than 3 weeks? P28: No. LB: No. Would you say you had a smokers cough... P28: No I wouldn't actually! Would you? No. P28P: Not really. P28: No, never hacking coughs or anything. P28P: not a dry cough like () LB: Sorry you didn't have a dry cough? P28P: No. No. ((pause)) No more than a lot of people have got you know. In the day and you know