Table 5

Prerequisites for closure of diagnostic process. Question: Can you try and explain what made you stop the process at this particular stage?

Perception of patient systemically well or unwell
  • Well: I didn't think she was medically kind of unwell (4); vital signs were good (13);

  • Unwell: She looked ill and she was vomiting profusely (19);

Ruled out urgent or severe illnessurgent problems…excluded…don't really know what's going on now, but I didn't think it was anything serious (3); I felt I'd done more excluding than I had done confirming (17);
Ruled in non-urgent diagnosis with satisfactory confirmationknow it's to be one of the simpler things but you have to ask the questions, and I guess how much is enough I mean at the point when I'm satisfied that there is significantly more confirmation of one of the simpler things than one of the nasties (5); the history and the examination coalesce on a simple diagnosis (11);
Red flags present or absentketotic…don't think I could have done anything else (13); her gait was staggering (21);
Set up good safety netsafety netting because everyone makes mistakes, (1 9); I normally very scrupulous about safety netting because I'm paranoid about missing things (7); a gold star safety net in this case…driver knew the patient (2);
Responded to patient's needs…in terms of the diagnosis I think I was less than 50% sure…, but in terms of what was best to do for the patient…towards 100% (18); I hadn't succeeded in allaying his anxieties (6); Stop since good explanation that is rule in and also consistent with parent expectations (7);