Table 4 Misunderstanding diagnostic strategy (Patient 2 and GP 1)

Patient 2 (female, 58 years old)

GP 1 (male)

How are you feeling at the moment about the diagnosis?

R: I’m a bit confused how they are linked. Whether it is two separate conditions or…Some of the symptoms are…are similar. Yeah

Do you feel that the consultation, at the end, was it clearly linked to an action? Did you understand what was going to happen next?

R: Not really, because there was no suggestions for what I could do in the next sort of three or four weeks which would take me up to the end of the three-month period other than increasing the medication for the reflux, but not really anything about the whooping cough

So, it wasn’t clear to you what you should do if anything changed?

R: If I needed to rest or if I needed to drink different amounts. If maybe he’d known a little bit more about the acid reflux and other symptoms. That must’ve been somewhere back on my records because I went through quite a lot of testing and they found that I had a hernia, and nothing was sinister then. So, it’s just at the back of my mind. As he said, I can’t be absolutely certain. I know they do normally say that

So, there are viruses called parapertussis viruses that are very like whooping cough viruses that are continually circulating in the community and they frequently, not infrequently, can cause persistent coughs with paroxysms of coughs where you cough, cough, cough and can´t stop yourself coughing and they last ages. They last sort of three months and so with her I think with an eight-week history that was paroxysm and to me it was probably that or it´s silent reflux, so I've given her treatment for silent reflux and I'll see her again. To be honest if it´s parapertussis it would have cleared up by the time I see her again anyway so if it´s cleared up I'll just stop the PPI. If it´s not cleared up I'm guessing I'm probably going to be looking to refer her, probably just a respiratory referral