Experiencing a first surgical consultation : patients' interaction in an outpatient clinic

Using a grounded theory approach, this study, sets out to explore and elicit the patients' experience during the initial surgical consultation in an outpatient clinic. Its purpose is to derive an analytical understanding of patients' enactment of their role through observation of surgeon/patient interactions, to describe and explain how patients perceive their role during consultation and generate a theoretical framework. It is unique in using `patient voices' as a means of substantiating theories and observations distilled from data collected.

The research question posed was:

How do patients describe their experience of the first consultation with a surgeon?

Following Ethics Committee approval, a sample of thirty patients (following theoretical saturation), not previously seen by the consultant, were recruited from a surgical outpatient's clinic. Theoretical saturation was reached when no further properties or relationships of note were generated by the data captured. Theoretical sampling developed the emerging categories making them more definite and pinpointing the fit and relevance of categories. Three sets of audio-taped patient data, (at pre-consultation, intra-surgeon/patient consultation, and postconsultation interview), were transcribed verbatim. A fourth set of data (surgeon/researcher interview) was obtained on cessation of patient interviews.

Data collection and analysis were managed simultaneously using `constant comparative analysis' to reveal five categories: Experiencing crisis, Regaining control, Seeking engagement, Constructing partnership and Sensing relief. The category Playing the rules of the game emerged from the surgeon/researcher interview; this tested the hypothesis that interpersonal skills are learnt `on the job'. The core category, Seeking peace of mind, uncovered the essence of the study and represented the concept most significant to patients. An Assessment Triad, a composite of the three categories experiencing crisis, seeking engagement and/or regaining control, which emerged in the initial patient/researcher interview is presented to facilitate this `search' and to uphold the ethos of patient-centeredness a dictum embedded in all Government initiatives.

The findings of this study offer grounded evidence of patients' experiences and needs before a surgical consultation in the format of an assessment triad, a tool used to question and prompt clinical practice in order to foster patients' search for peace of mind; and issues pertinent to the role of medicine and professions allied to medicine. These findings can inform future presurgical and perioperative protocols and professional education by ensuring that patient empowerment, patient-centredness and their search for peace of mind are incorporated into patient/healthcarep rofessionalc onsultations.