‘My first thoughts are...’: a Framework Method analysis of UK general practice healthcare professionals’ internal dialogue and clinical reasoning processes when seeing patients living with obesity in primary care

Serjeant, Sarah, Abbott, Sally, Parretti, Helen and Greenfield, Sheila (2025) ‘My first thoughts are...’: a Framework Method analysis of UK general practice healthcare professionals’ internal dialogue and clinical reasoning processes when seeing patients living with obesity in primary care. BMJ Open, 15. ISSN 2044-6055

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Abstract

Objectives: To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity. Design: This study utilised an exploratory qualitative research design. Data were collected using semi-structured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient photograph, name, age, and body mass index. Participants were asked to describe their first impressions of each fictionalised patient. Setting: Interviews were conducted remotely via Skype between August and September 2019. Participants: A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. Twenty participants were interviewed (11 general practice nurses and nine general practitioners). Results: Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors, and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs’ assumptions around patients’ lifestyles, occupations, and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments. Conclusions: Whilst it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.

Item Type:	Article
Uncontrolled Keywords:	sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine
Depositing User:	LivePure Connector
Date Deposited:	04 Apr 2025 14:30
Last Modified:	07 Apr 2025 00:19
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98948
DOI:	10.1136/bmjopen-2024-086722

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