The views of primary health care professionals about the management of breast problems in clinical practice

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Abstract
To identify primary health care professionals' views about patients presenting with breast problems, and their approaches to clinical management. Qualitative study using practice-based semi-structured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practices; 15 of the 34 study practices were audio-taped. Groups comprised the partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses, 51% attended. In all, 86 professionals attended the meetings. A number of themes arose consistently from the discussions. Participants were concerned about the possible consequences of errors in diagnosis and about difficulties concerning the 'management of uncertainty'. Doctors were influenced especially by adverse past experiences. Other difficult situations included referral decisions and the management of risk factors in isolation from clinical presentation. Outside influences on presentation and management, such as the media, were also noted. The management of breast disease is perceived as a complex issue by health professionals. The patient and doctor contextual factors described must be taken into account in discussions about what constitutes appropriate clinical management and in the development and implementation of clinical guidelines to improve management.