Table 6.

Problems with the Empathico consultation from patients' perspectives.

Problem	Sample quote	Solution
Practitioner did not explore the patient's expectations about treatment.	”I think the only person who knows your body is yourself - although I suppose, in my case, I could be completely wrong - but you think you do, and the assumption was that no surgical intervention was deemed necessary at this stage however correct that might be and it's those sort of possibilities that I would have like to know more about.“ (male, 61–70 yrs, knee OA)	Acknowledge patient's goal and expectations about treatment.
Lack of explanation for recommended treatment.	”She didn't go into […] the construction of the knee, and how if you can strengthen the muscles that are holding the knee in place. So she didn't fully explain. She just said these exercises will help the joints and muscles. I think she could have been far more explicit as to how important it is to strengthen the muscles holding the knee in place.“ (female, 71–80 yrs, hip and knee OA)	Where appropriate, explain underlying pathology and justification for treatment.
Balancing motivation with realistic outcomes.	”I suppose on reflection she perhaps could have pressed a bit more to try to motivate him a bit more, but then to try and motivate him you're probably going to give him a false expectation. If she makes too much of it, which motivates him, and it doesn't happen, that's worse. So it's six of one, and half a dozen of the other really.“ (male, 71–80 yrs, hip OA)	Ensure optimism is conveyed realistically and appropriately.
Practitioner didn't seem to know the patient's history	”The patient had to start at the beginning again and go through, which was not a good thing.“ (female, 71–80 yrs, hip and knee OA)	Recommendation to read patient notes prior to consultation.
No plan to review progress was made.	”[The doctor could have said] 'Let's do this 3 months, and let's come back and see me, and then we'll move forward;' rather than leaving it open-ended [.] That would give him much more confidence that he's been managed." (male, 51–60 yrs, hip OA)	Optimism about self-management, clear explanation (OA does not necessarily get worse), positive safety netting.