Table 3

Transcribed examples of statements conveying decisions according to DICTUM

Category subgroupPhysician statementContext
1Order test‘I'll get an ultrasound of it tonight’ER, internal medicine, deep vein thrombosis?
‘There is no point in a new EEG now’OPC, neurologist, epilepsy
‘You'll send in faecal tests after four, six and 8 weeks…’OPC, gastroenterology, Crohn's disease
‘We'll do the A1c and some blood tests afterwards’OPC, endocrinology, type 2 diabetes
Consulting colleague‘This is a bit special so I will discuss it with a colleague’OPC, gastroenterology, Crohn's disease
‘I will discuss it a bit with my consultant’IPW, nephrology, respiratory infection?
External information‘We will get those images sent over and have them assessed’OPC, urology, kidney tumour
2Good‘140/80… I think that is very good’OPC, nephrology, chronic kidney disease
‘I see that your A1c is 8.1, that is great’OPC, endocrinology, type 2 diabetes
‘The X-ray looks fine’OPC, orthopaedics, hip replacement FU
‘Everything was in perfect order; I found nothing wrong’ (after full neurological examination)OPC, neurology, headache
Bad‘Your A1c was not so good’OPC, endocrinology, type 2 diabetes
‘You are a bit low on potassium’IPW, infectious disease, erysipelas
‘Your blood pressure is high. 180/100 is high’OPC, cardiology, thoracic aorta graft FU
Ambiguous‘It wasn't too bad, but it's not great either’ (after lung auscultation)IPW, infectious disease, pneumonia
3Diagnosis‘This is a classic case of light asthma’OPC, infectious disease, sinusitis and dyspnoea
‘Ganglion [cyst] it is called’OPC, orthopaedics, lump on wrist
‘Based on today's examination I think it is more likely that you've had a minor stroke’IPW, neurology, left side paresis
‘This is basically what we call osteoarthritis’OPC, orthopaedics, knee pain
Aetiology‘I think it is paracetamol and dextropropoxyphen that has damaged your liver’IPW, gastroenterology, pneumonia
‘It is the torn cruciate ligament that prevents your knee from stopping where it should’OPC, orthopaedics, knee pain
Prognosis‘The chemotherapy cannot remove what you have on your lungs’OPC, oncology, lung metastases
‘You can profit on training up to a year after the injury’IPW, neurology, stroke
Evaluating state of health‘Your diabetes is very well regulated’OPC, endocrinology, type 2 diabetes
‘He's breathing nice and slowly, I think he has responded well to treatment’IPW, paediatrics, bronchiolitis
4Start‘We'll start with azathioprine 50 mg’OPC, gastroenterology, Crohn's disease
‘I was thinking you should get desloratadine, allergy pills’OPC, paediatrics, IBD and seasonal allergy
‘We'll give a 4-day treatment of dexamethasone’IPW, paediatrics, bronchiolitis
‘I would like you to get some vaginal oestrogen’OPC, gynaecology, uterine prolapse
Refrain‘We cannot give you chemo today’OPC, oncology, GI-cancer, low neutrophil count
‘You should not take ibuprofene or other blood thinners before the surgery’IPW, anaesthesiology, preoperative assessment
Stop‘It means that you can stop taking β-blockers’OPC, cardiology, tachyarrhythmia
‘You should cut the iron tablets’OPC, cardiology, chronic heart failure
Alter‘You'd better reduce to 50 [micrograms of levothyroxine]’OPC, endocrinology, Graves’ radio-iodine FU
‘Go down to two plus two [prednisolone 5 mg]”OPC, gastroenterology, Crohn's disease
‘You should increase the insulin detemir dosage 2 units at a time’OPC, endocrinology, type 2 diabetes
Maintain‘You should continue taking salbutamol when you need to’OPC, paediatrics, asthma and allergy
‘Cortisone, you'll take as earlier’OPC, endocrinology, Addison's disease
‘As a foundation you should always take paracetamol 1 g 4 times a day’OPC, oncology, metastasised GI-cancer
5Surgery‘It's alright to get this operated’OPC, gastro surgery, haemorrhoids
‘We cannot operate more on you’OPC, orthopaedics, elbow fracture FU
Radiation‘And I will refer you to radiation therapy’OPC, haematoid-oncology, chemotherapy
Interventional radiology‘As long as you are good we are not going to do anything now’ (angiography/PCI)OPC, cardiology, coronary artery disease
Focused care‘We'll take off this part of the cast so that you'll be able to bend your finger’OPC, orthopaedics, lower arm fracture FU
‘I think you should go a couple of weeks without the [vaginal] ring’OPC, gynaecology, uterine prolapse
‘You don't have to change on the wound every day, it only irritates, let it be’OPC, gastro surgery, laparotomy FU
6Drug refund‘Esomeprazole and pantoprazole are the same, pantoprazole is cheaper and the State has decided that you should drive an Opel, not a BMW’OPC, gastro surgery, laparotomy FU
‘Owing to this [muscular stiffness on simvastatin] you qualify for atorvastatin’OPC, nephrology, chronic kidney disease
Sick leave‘You will get a sick leave note from us’ER, shortness of breath, admittance
‘We'll keep it like that [50% absent from work]’OPC, orthopaedics, leg fracture FU
‘You will be in paid leave from work for at least 3 months’IPW, neurology, stroke
Disability‘The way you function right now you cannot drive your car’IPW, neurology, stroke
7Schedule‘I'll schedule a control for you here in 3 months’OPC, gastroenterology, Crohn's disease
‘I won't schedule a new control here, seeing that you have a new appointment at the cancer centre’OPC, haematology-oncology, radiation
AdmitTo patient's mom: ‘My suggestion is that he is admitted to the bed ward’OPC, thorax surgery, pneumothorax
‘I think you should spend the night in our observation ward’ER, internal medicine, shortness of breath
‘She is so weak that she should be admitted’ER, paediatrics, vomiting
Discharge‘We are going to have to send you home while we wait for an opening [at the nursing home]’IPW, cardiology, arrhythmia, not self-sufficient
‘We thought you were going to get to go home today’IPW, cardiology, bleeding ulcer and heart failure
Telephone‘I'll call you when I get back the results’OPC, haematology-oncology, Waldenstrom's disease?
Referral‘I will refer you to a neurologist’OPC, oncology, metastasised renal cancer
‘I'm thinking I'll send a referral to a physiotherapist’OPC, gynaecology, uterine prolapsed
8Smoking‘I would recommend you to cut it completely’OPC, type 2 diabetes, weekend smoker
‘It will require effort from you—you will have to stop smoking’IPW, cardiology, recent heart attack
Exercise‘I would recommend you to increase your level of activity’OPC, endocrinology, type 2 diabetes
‘I would stay away from soccer’OPC, orthopaedics, ACL rupture pending surgery
Diet‘Mind the calories; sweetened beverages, potato chips, cakes, sauces…’OPC, gastro surgery, rectal cancer FU
Weight‘The weight increase should not continue, then you'll have crossed a line’OPC, nephrology, chronic kidney disease
HydrationTo boy's mom: ‘He should get at least 3–4 glasses [to drink] per day’IPW, paediatrics, gastroenteritis
‘Be careful to drink a lot of water’OPC, gastro surgery, sigmoidostomy
Alcohol‘Together with warfarin, it's not advisable to drink alcohol’IPW, cardiology, right-sided heart failure
Mobilisation‘Be careful with sudden movements and heavy lifting’IPW, cardiology, recent coronary bypass
‘Avoid activity that you notice makes this worse’OPC, neurology, neck pain, numbness in arm
‘Mind keeping the leg high while you are sitting’OPC, orthopaedics, leg fracture FU
Sleep‘Staying up late lowers the threshold for cramps’OPC, neurology, epilepsy
Precaution‘If you were to get a fever, you have to contact a doctor’OPC, gastroenterology, Crohn's disease
‘If you start bleeding heavily [from your bowels], you have to contact the hospital’OPC, gastroenterology, ulcerous colitis
‘However, if it gets more painful in the chest or something like that, you'll take contact’OPC, cardiology, coronary artery disease
‘If it doesn't get better, call 911’OPC, cardiology, coronary artery disease
9Quantitative‘The goal has to be that it should be 120/80’OPC, type 2 diabetes, BP 135/80
‘We want to get the A1c down between 7 and 8’OPC, type 2 diabetes, A1c 9,2
‘I would like to see your viral counts under 50’OPC, infectious disease, HIV, viral count 700
Qualitative‘What you should work on the next year is building your strength’OPC, orthopaedics, knee prosthesis FU
‘Seeing that this is a curative setting I don't dare to lower your dose’OPC, oncology, GI-cancer
‘The goal has to be to get as good as you were before’IPW, neurology, stroke
10Transfer responsibility‘I don't know for sure, but they know all about it at the cancer centre’OPC, haematology-oncology, radiation
‘The issue of your driver's license, you have to discuss with your family doctor’IPW, cardiology, chronic heart failure
Change subjectPatient asks about prescription for sildenafil—physician changes topicOPC, infectious disease, HIV
Wait and see‘We'll see how it goes’IPW, gastroenterology, abdominal pain
‘I would like to wait and see [with regards to implantation of grommets]’OPC, ear-nose-throat, fluid in ear
‘I think we'll wait and see for 4 weeks’OPC, neurology, neck pain, numbness in arm
Active and specified‘I'll have to think about this [choice between sunitinib and interferon treatment]’OPC, oncology, metastasised renal cancer
  • ACL, anterior cruciate ligament; A1c, glycated haemoglobin; BP, blood pressure; ER, emergency room; FU, follow-up; GI, gastrointestinal; IBD, inflammatory bowel disease; IPW, inpatient ward; OPC, outpatient; PCI, percutaneous coronary intervention.