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Table 4 Talking about success (b): Craig, Medical specialist, neurology, Scotland

From: “Was that a success or not a success?”: a qualitative study of health professionals’ perspectives on support for people with long-term conditions

Interviewer: … examples or case histories from your experience of something that would illustrate your idea of success?
Participant: Erm. I guess that depends on what we’re doing and it also depends what stage of the condition the patient’s at. So … for Parkinson’s I would say that there are four stages of the condition … So what counts as a successful encounter… depends on what the issue is for that patient at that stage, and my guess is that you might define success and failure differently for different scenarios. Although I dare say there will be some features that would be common to all.
Interviewer: And can you say a bit more about what they might be, from your experience?
Participant: Erm. I suppose, if you’re looking at generic things, I suppose it would be issues with communication: honesty, accuracy … building and maintaining a relationship. From a patient’s point of view I think they value seeing someone who knows about their condition … I suppose a successful consultation has to have sufficient time, but it also has to occur at the right time… Those are the things that spring to mind. …
Interviewer: … do you have any examples … of what you would describe as maybe a successful early encounter?…
Participant: I think you would have to ask the patients about that, you know. What is success from my point of view might be rather different from success from their point of view… One encounter that I recall… was a… worker in his 40s with a bit of a tremor, and I told him I thought he had Parkinson’s Disease. He didn’t like that [and went off and saw a neurologist elsewhere who] said it was probably a form of essential tremor, so he was very happy… Unfortunately his symptoms got gradually worse [and the other neurologist] eventually agreed that he did have Parkinson’s Disease… So now, I don’t know, was that first encounter a good one or a bad one? I was right, and I love being right [laughter]… but I told him information that he wasn’t happy with, and which maybe he wasn’t ready to accept at that stage. So I don’t know how you judge whether that was a good encounter or not…
Interviewer: … would you be able to define success in your view of encounters with people with Parkinson’s [in the early stages]?…
  Yeah, so communication, I suppose accuracy in the information that we provide… the way in which it’s communicated, ‘cause I guess the quality of communication will always make a difference to how people take things in. And the back-up available. I suppose that’s the other thing… quality … isn’t necessarily [just] about what happens during that appointment … For example, if somebody is complaining that their speech has deteriorated and they want a drug to make that better, if I say “Well, no drug is going to make your speech better…, but we’ll refer you to a speech therapist”, they may be disappointed but they are at least going to see someone who can maybe advise them about that symptom and help them cope with it better…
  … In a sense, I don’t have a desired result really, other than the best for the patient. It has to be the patient’s desired result really, not mine.