Table 2.
Meaning units, categories and themes
| Meaning units | Category | Themes |
|---|---|---|
| (Quotation A) | Guidelines trusted | Attitudes to guidelines |
| “and I think that’s nice, because I…you know, I think that…they think I look young or small and a girl and all that, and what would you know about it, then it’s very nice to be able to say that it’s not just me who thinks something, it agrees with something that is generally recommended” (Interview 12, p. 17) | ||
| (Quotation B) | Guidelines of little concern for practice | |
| “The guidelines are always right, I think, but we must see the patient and then use those guidelines on the patient, so it must…we must use our brain. I feel it’s not as simple as to…just to take the guidelines and then…no, you must make the right diagnosis and then you can use guidelines” (Interview 14, p. 20) | ||
| (Quotation C) | Adherent to guidelines | Diagnosis of GAS |
| “If they have had a fever at least 3 days and absence of a cold and cough then I would always prescribe a RADT.” (Interview 17) | ||
| Quotation D | Non-adherent to guidelines | |
| “If they then have what’s typical for me, that they have a swollen throat with a really, you know, nasty throat, and lymph glands on the throat and just throat symptoms and fever, then I tend to think like this, yes, this is classic tonsillitis, then I don’t take any tests.” (Interview 2, p. 2) | ||
| Quotation E | ||
| “But sometimes I’m uncertain, and then I take and I see that tonsillitis is… the patient has enlarged tonsils and redness, but if there’s no furring or anything, then I can take Strep-A.” (Interview 22, p. 5) | ||
| (Quotation F) | No fear | Fear of bad outcomes |
| “No I [am not afraid]. It could be both a streptococcus infection and mononucleosis, but then they won’t get well, they will return and then you’ll check for mononucleosis.” (Interview 19) | ||
| (Quotation G) | Fear | |
| “I have seen some examples of that, which are frightening, for instance these lateral…whatever it’s called. So I want to rule that out. And then I think that…you know, this thing with incipient peritonsillitis you have to be a bit observant about.” (Interview 7, p. 10) | ||
| (Quotation H) | Not possible to identify | DD and complications possible to identify |
| “That’s what I find most difficult because you have to look down there properly, I think, in the larynx and look at the vocal cords and dare…so to speak, someone who’s hoarse, to see that it’s not something malignant, that you miss something dangerous, I find that really difficult. You often end up in the situation that you’ve seen a little, but not enough to rule out completely that it could be dangerous.” (Interview 6, p. 2) | ||
| (Quotation I) | Possible to identify | |
| “When they say, for example, that the find it hard to open wide, I think that often they come here and sit in with the nurse and the nurse is a bit uncertain, then I usually go in and take a look and then you can see. And then it’s mostly a matter of a…is it a sore throat or is it actually peritonsillitis.” (Interview 12, p. 15) | ||
| (Quotation J) | Adherence to guidelines | Coping strategy |
| “I think it’s good that we have these Centor criteria, you know, rules, because it’s…well, if you follow them it’s not difficult.” (Interview 17, p. 7) | ||
| (Quotation K) | Clinical picture and CRP | |
| “In my view the clinical assessment is the most important” (Interview 14, p. 6) | ||
| (Quotation L) | ||
| “Then I take CRP too, to know whether it’s over 50 or 60, then you think it’s something more bacterial than virus.” (Interview 22, pp. 7–8) | ||
| (Quotation M) | Expanded control | |
| “But I am still very careful to look down the throat, I must say that, and perhaps you feel a greater need to check with the years, when you’ve seen that there can be things there.” (Interview 7, pp. 3,9) | ||
| Quotation N) | Unstructured | |
| “Well, I ask the patient of course, how long, how much it hurts, where it hurts, if they have difficulty swallowing, if they have a temperature, if it’s the first time, if they recognize it or if it’s something they’ve have before, if they’ve had it recently and had the same symptoms and if they’ve been to the doctor and had treatment for it, if there’s anyone in the family who’s been sick, or that they’ve met…that that person has met someone who has had the same illness. That means I’ve sort of covered a bit there. And then I ask what they work at, I ask if they have children, I ask general questions and then the usual history taking… I ask if they have earache or some other respiratory tract symptoms that might be connected to it, you know, earache or a cough or a cold, that kind of thing, sore joints…you know, the most usual things. Well, then I examine the patient so that I look in the ears, nose, throat, right, and feel the lymph glands on the throat and often, in fact, I listen to the lungs too, since they’ve come for a consultation anyway.” (Interview 2, p. 1) |