Table 2

Themes and illustrative quotes
Quote letter (used in text) Illustrative quote (participant ID in brackets)
Patients’ expectations of tests and beliefs about x-rays
A Because it … was pretty bad, so I figured… need [an x-ray] to see what it was...They [x-rays] can isolate the problem (P1)
B I thought it [x-ray] might show the cause in my spine. I think it helps (P4)
C I guess [an x-ray] was to establish whether, from my perspective, whether it was just a pulled muscle or whether it was called herniated disc or whatever. (P7)
D I knew there was something wrong and I thought well, I was just guessing and without actually seeing (P8)
E gave me a physical examination and she said well clearly there was a problem and maybe we should confirm her findings with an x-ray… (P5)
F …the whole thing sort of confirmed what we knew, that I had wear and tear (P11)
G … to find out what it is and try to fix it (P7)
H No, just positive reassurance I think. (P10)
I I think they’re like the last resort because it’s like radiation on your body, like if it’s not necessary and plus it’s the hours of your whole day that you’ve got to take out to get it done and wait. (P1)
J The only downside maybe … was the radiation, but that was the only negative. I think the less radiation you can be exposed to the better, but that having being said the results justified that risk. I would rely on my doctor’s advice. (P8)
Patients’ treatment expectations
K I had no expectations. (P5 and P8)
L I thought she’d say go see a physiotherapist, and she was going to give me a letter yesterday but she said she’ll get the results of the x-ray first. (P2)
M I didn’t think that a doctor could do anything apart from give me pain relief as in medication (P3)
N I had no idea, so I guess, a painkiller obviously. The other thing, um the anti-inflammatory, I guess I didn’t expect an anti-inflammatory but it worked really well (P7)
O I think [the GP] should always try to find out what the cause is and take steps to eliminate that if possible, even if it’s just a simple exercise or even if it’s just lying down, I think it’s important that they try and find a way of helping the situation. (P4)
P Because if you don’t get something treated it can impact on other parts of your body. (P9)
Q I kind of felt either I’d left it too long and it’d got to the stage where it just needed something. (P10)
R It depends, I suppose. In my case it was quite severe and I had, there was no option but to get something done. (P8)
Influences on patients’ expectations
S I’d heard about friends having MRIs and the osteopath suggested that I have an MRI to look at the soft tissue, and [the doctor] suggested the x-rays and I did have the x-rays and the verdict is that there is wear and tear (P11)
T [The chiropractor] said to me ‘Before I touch you I want you to get an x-ray done.’ (P10)
U Because that’s what’s happened before (P8)
V Probably because I’d never had one [x-ray]done, and that’s the usual, the doctor probably wants to see what’s happening. (P4)
W Physio wasn’t working…it wasn’t getting better… and I knew that I needed to sort of have something further checked out (P11)
X Well in most cases that I’m aware of your doctors just tend to put a patient on anti-inflammatories and away you go. (P9)
Y I assumed I probably would get some sort of anti-inflammatories… because it was a muscle… (P5)
Z Anti-inflammatories… aren’t they like strong antibiotics that will deal with the infection? (P11)
Importance of the GP-patient relationship
AA I suppose it’s like any clinical part of what a doctor does, it’s the experience, the amount of patients they see, that they find the tried and true methods and that’s what happened. (P5)
BB I went and saw my doctor again because I was happy with past results and she knew my history (P8)
CC I’m sure he’s got guides as to what to use when, so, and experience. (P7)
DD Yeah, a lot depends on sort of your relationship with your GP. I think in this case the doctor’s advice is good (P10)
EE I knew she would zero in on what the problem was… I was quite happy to leave it in her hands. I would rely on my doctor’s advice (P7)
FF [My doctor] has been treating me for quite a long time, and she has been extremely proficient at diagnosing things I have, and… she knew what she was doing. She had come across this before… and immediately zeroed in on the problem. Her experience was a factor, and my experience with her as a doctor immediately made me go straight to her and say look, I need help here. (P8)

Hoffmann et al.

Hoffmann et al. BMC Family Practice 2013 14:7   doi:10.1186/1471-2296-14-7

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