title: How does the thought of cancer arise in a general practice consultation? Interviews with GPs.
abstract: BACKGROUND
  Only a few patients on a GP's list develop cancer each year. To find these cases in the jumble of presented problems is a challenge.
  
  
  OBJECTIVE
  To explore how general practitioners (GPs) come to think of cancer in a clinical encounter.
  
  
  METHODS
  Qualitative interviews with Norwegian GPs, who were invited to think back on consultations during which the thought of cancer arose. The 11 GPs recounted and reflected on 70 such stories from their practices. A phenomenographic approach enabled the study of variation in GPs' ways of experiencing.
  
  
  RESULTS
  Awareness of cancer could arise in several contexts of attention: (1) Practising basic knowledge: explicit rules and skills, such as alarm symptoms, epidemiology and clinical know-how; (2) Interpersonal awareness: being alert to changes in patients' appearance or behaviour and to cues in their choice of words, on a background of basic knowledge and experience; (3) Intuitive knowing: a tacit feeling of alarm which could be difficult to verbalize, but nevertheless was helpful. Intuition built on the earlier mentioned contexts: basic knowledge, experience, and interpersonal awareness; (4) Fear of cancer: the existential context of awareness could affect the thoughts of both doctor and patient. The challenge could be how not to think about cancer all the time and to find ways to live with insecurity without becoming over-precautious.
  
  
  CONCLUSIONS
  The thought of cancer arose in the relationship between doctor and patient. The quality of their interaction and the doctor's accuracy in perceiving and interpreting cues were decisive.
authors: Department of Community Medicine, University of Tromsø, Norway. May-Lill.Johansen@uit.no
authors: May-Lill
authors: ML
authors: Johansen
authors: Knut Arne
authors: KA
authors: Holtedahl
authors: Carl Edvard
authors: CE
authors: Rudebeck
mesh_terms: D002983:Clinical Competence; D005194:Family Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019545:Intuition; D009369:Neoplasms / Q000175:diagnosis*; D009664:Norway; D036301:Qualitative Research; D012017:Referral and Consultation; D011795:Surveys and Questionnaires