21 Provision of timely care within a primary care setting has many challenges, for example due to patients having difficulty in attending consultations during regular general practice hours.
Since findings of our study highlight the particular difficulties of broaching the topic in consultations about unrelated problems, future research could focus mainly on exploring this in more detail.
(Harry, male, 40s) Some participants clearly recognised that their own anxieties could also contribute to their difficulties with understanding what was said in consultations, both because they impaired listening and concentration, and because they deterred them from asking questions.
Parents reported that clinicians provided sufficient information in consultations but they had difficulties in retaining verbal information to convey to other family members.
(DS029, F, 54, BtB) Furthermore, a lack of time in the consultations and difficulties in providing continuity of care were frequently cited reasons for the lack of GP initiated follow-up from the patients' perspectives: I wouldn't have expected a GP to call me.
From the patients' perspective, the results may reflect their difficulties in expressing ambivalence in the consultation or unconsciousness of their ambivalence before and during the consultation, which is underlined by the fact that the patients expressed that they were much more conscious of their ambivalence in the weeks after the consultation.
A general finding made in an investigation by Arborelius et al. [ 36] was that GPs do not usually allow themselves to show feelings of uncertainty in consultations that they have difficulty grasping.
These include: difficulties in applying generic guidelines to individuals presenting in consultations, patient resistance to taking aspirin, the prioritisation of other issues in a time constrained consultation and problems in reviewing the medication of existing stroke patients.
The first focus group discussion (GPs with an academic working career in Nijmegen) revealed that difficulties in a good explanation was an important topic in consultations with MUS patients.
Adding accurate laboratory testing data to ILI addresses the otherwise substantial difficulty in estimating ILI consultations due to influenza, and results in estimates that are less sensitive to parameter misspecification.
