Domains, Major Themes, and Representative Quotes Regarding Diagnostic Referrals
| Domain | Theme | Illustrative Quote |
|---|---|---|
| Cross-Cutting | Clear Communication as Empowering | They sometimes (ask): ‘Do you have any questions?’ But some people don’t really know what to ask…, about (the topic). I say, no, I don't have no question, because I don't know what to ask. And when I get home, some people ask me questions. I say, hmm…it’s true: I should have asked that. You know …they should give more information. |
| Importance of Clinician-Patient Communication about the Referral | Agreement with Referral | My primary care physician took a look at it and said she would feel much better having a dermatologist look at it, and we both agreed that she would make a … referral |
| Unclear Rationale for Referral | They said they needed to do a stress test to see what was going on. To define what was going on. But they didn’t explain what the test is, what they were going to do, nothing. I just got there and I went to the machine and you're going to do this, you're going to do that, that’s it. She felt that she couldn't tell me exactly what was going on and that the expertise of a dermatologist would probably be better. | |
| Ambiguous Urgency and Time Frame | I felt that they never thought it was a life-threatening situation. So it was more like: Is (it) convenient for you to have this done? I kind of had a sense that it wasn't extremely urgent, or else he would have said, like go to the emergency room right now. | |
| Desire for Transparency and Clear Language | I would ask them to be 100% transparent and communicate to the best of their knowledge how risky the condition is, to allow me to figure out how much concern I should or should not have. If someone could have said: “Well, here's the process that we go through. You'll be examined, your physician will be so and so, followed by discussion of what the physician perceives to be the cause of my skin outbreaks and comment about how concerned I should be about them.” But I didn't get any of that stuff. I would’ve appreciated more information about it… in layman's terms" | |
| Emotional Context- Fears, Concerns, and Anxiety | My worry was the injection they were going to give me (for the stress test) (translated from Spanish) In other words, as soon as you run the test I’m scared. The essential thing is that the distance between point A and point B be as short as possible, even if B is bad news. I just can’t handle the wait. My primary said that probably is nothing to be scared of. I was calm, you know, but I feel scared, because when it's the heart it’s the heart. You don't know…” | |
| Challenges in Arranging the Referral | Health System Delays and Challenges | They tell you (that) you may have skin cancer, and it's taken forever to get an appointment" It just seems like the medical professionals are overwhelmed and short staffed. There's a long wait, you know… it shouldn't be that way. |
| Trust in Physician and Health System | They sometimes act like they don't believe what you're saying | |
| Logistical and other Barriers | The only problem (is distance) and it's our fault because we live far away…So it’s logistics. So I'm definitely going to pursue it. It's just you know, life got in the way. (….)Dermatology calling me would have made it easier. | |
| Inconsistent Referral Processes, Diffuse Responsibility, and Uncertainty | I thought that he was gonna take care of booking it, and then I found out later that he (…) wanted me to actually do the booking, …the call. There were…at least five things that I was responsible to get taken care of. I guess it wasn't clear enough. …All the other things were taken care of by the office. |