Table 3

Key themes to differentiate between straightforward and demanding presentations. Question: Can you explain why you felt that Case 1 was straightforward and second one more demanding or difficult? (S: straightforward, D: demanding)

ThemeExample
Salient feature rapidly recognised or unclear

  • S: fine within about one minute of seeing the baby just by looking (3);

  • D: vague and there was sort of lack of symptoms a lack of I suppose a good history (4);

Familiar or not

  • S: just the run of the mill you know straight forward diagnosis that you see commonly everyday (10);

  • D: uncomfortable because I had not seen a rash quite like that before (7);

Age group

  • S: easy presentations occur in young people with no medical history and whom you don't have to worry at all about referring to old notes (15);

  • D: chronic ongoing problems where lots of doctors (16);

Degree of ongoing uncertainty

  • S: it's about the degree of risk that I take…it is about the degree of confidence that I have whether I can help them or not (14);

  • D: I had a degree of uncertainty about the second case that I didn't have about the first one (12);

Severity of illness

  • S: Global impression that child is well [or the other] be dead in a few hours (1); If not serious, may or may not know the diagnosis but does not matter (6); you cannot make a definite diagnosis, no red flags (13);

  • D: more difficult I think the fact that there was a longer differential…the stakes were higher…I had a degree of uncertainty (12);