‘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

Sarah Serjeant; Sally Abbott; Helen M. Parretti; Sheila Greenfield

doi:10.1136/bmjopen-2024-086722

‘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

Sarah Serjeant
, Sally Abbott
, Helen M. Parretti
, Sheila Greenfield

University of East Anglia
University of Birmingham

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

11 Downloads (Pure)

Abstract

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. This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient. Interviews were conducted remotely via Skype between August and September 2019. A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners). 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. While 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. [Abstract copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.]

Original language	English
Article number	e086722
Number of pages	9
Journal	BMJ Open
Volume	15
Issue number	4
Early online date	2 Apr 2025
DOIs	https://doi.org/10.1136/bmjopen-2024-086722
Publication status	Published - 2 Apr 2025

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.

Funding

We thank the GPs and GPNs who participated in the study. We also thank both the individuals and the Royal College of Nursing, who shared the recruitment advertisement for this study with their social media networks. Salary for one of the authors (SA) was funded by a National Institute for Health Research (NIHR) Pre-Doctoral Clinical Academic Fellowship for this project. The study costs were funded by a grant from the British Dietetic Association General and Education Trust Fund. This paper presents independent research funded by the National Institute for Health Research (NIHR) (ICA-PCAF- 2018- 01- 021) and the British Dietetic Association. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, the British Dietetic Association or the authors' employing universities. Salary for one of the authors (SA) was funded by a National Institute for Health Research (NIHR) Pre-Doctoral Clinical Academic Fellowship for this project. The study costs were funded by a grant from the British Dietetic Association General and Education Trust Fund. This paper presents independent research funded by the National Institute for Health Research (NIHR) (ICA-PCAF-2018-01-021) and the British Dietetic Association. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, the British Dietetic Association or the authors\u2019 employing universities.

Funders	Funder number
National Institute for Health and Care Research
Royal College of Nursing
Department of Health and Social Care
British Dietetic Association
British Dietetic Association	ICA-PCAF-2018-01-021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Clinical Reasoning
Obesity
Primary Health Care
QUALITATIVE RESEARCH

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Abbott2025VORFinal published version, 807 KBLicence: CC BY

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‘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 M. et al.
In: BMJ Open, Vol. 15, No. 4, e086722, 02.04.2025.

Research output: Contribution to journal › Article › peer-review

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‘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

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

Access to Document

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Cite this