Table 4 Major themes and subthemes emerging from interviews with 28 GPs

Challenges leading to diagnostic uncertainty

Patient complexity

Multi-morbidity, polypharmacy, social needs

Atypical presentation

Non-specific symptoms and signs

Knowledge of patient

GP workload, continuity of patient care

Approaches to recognising the suspected serious infection in older adults

History taking

Recognition of non-specific symptoms including confusion, falls, incontinence, unsteadiness, lethargy and vomiting

Change from baseline

Collateral history from relatives and carers, reviewing notes

Physical examination

Standardised systematic approach including temperature, respiratory rate, pulse, blood pressure and oxygen saturation

Exam findings often not considered trustworthy, role of gut feeling

Scoring systems

Judge disease severity, communication to secondary care

Strategies to manage diagnostic uncertainty

Investigations

Varied levels of trust in different tests, ease of access

Safety netting

Safety net through third party, shared decision making