Pulmonologists' personal decisions and emotions as described in the parallel charts, and their influence on the narrative style
| “Core” parallel charts | “Contingent” parallel charts | “Moral” parallel charts | |||||||
| Easy | Difficult | Evolved | Easy | Difficult | Evolved | Easy | Difficult | Evolved | |
| Total | 65% (n=98) | 2% (n=3) | 33% (n=49) | 72% (n=110) | 11% (n=16) | 17% (n=26) | 24% (n=14) | 46% (n=27) | 31% (n=18) |
| Reasons that led to therapy change | |||||||||
| Illness-oriented | 52% | 0% | 71% | 40% | 0% | 35% | 50% | 28% | 60% |
| “The change of therapy, combined with encouragement, was the change the patient needed to get out of the spiral of anxiety that enslaved him” | |||||||||
| “If we try to give you another bronchodilator instead of cortisone, it will be like having a car with two engines” | |||||||||
| Disease-oriented | 48% | 100% | 29% | 60% | 100% | 65% | 50% | 72% | 40% |
| “A proper diagnosis through anamnesis and spirometry. Therefore, initiated therapy recommended by the international COPD guidelines” | |||||||||
| “I explained to him that, after seeing the spirometry results, he could not fail to follow my advice and that I would facilitate his tasks with a simpler, but still effective therapy” | |||||||||
| Physicians’ emotions after communication of therapy change | |||||||||
| Satisfaction and trust | 55% | 33% | 37% | 51% | 15% | 24% | 55% | 19% | 8% |
| “I felt happy seeing that in a few minutes the husband, in front of the opportunity to modify a therapy that was not objectively optimal, returned to smile, with a much less concerned expression” | |||||||||
| Anger and discomfort | 5% | 67% | 37% | 3% | 62% | 14% | 27% | 5% | 46% |
| “I felt the patient distant and unwilling to follow the directions given, especially for what concerns the behavioural changes. It seemed that she did not care about her health” | |||||||||
| “Almost helpless … I thought it was a failure” | |||||||||
| Duty and responsibility | 40% | 0% | 37% | 46%% | 23% | 62% | 18% | 76% | 46% |
| “I felt I was responsible for his happiness” | |||||||||
| “I felt obliged to help him and make him change his mind” | |||||||||
| Smoking cessation strategies | |||||||||
| Reprimands | 24% | 100% | 35% | 67% | 75% | 54% | 80% | 90% | 89% |
| “I ask him if he still smokes and he answers yes. AT THIS POINT, I burst out and I rebuke him because he KEPT SMOKING. I added that it's not right that I and others have to sustain healthcare expenditure while he continues to be addicted to nicotine” | |||||||||
| Compromise | 57% | 0% | 48% | 27% | 25% | 38% | 20% | 10% | 11% |
| “I also took the opportunity to remind her of the damage of cigarette smoke and how she had been good recently, in reducing the daily number of cigarettes” | |||||||||
| Counselling | 19% | 0% | 17% | 7% | 0% | 8% | 0% | 0% | 0% |
| “During my next visit, I tried to make the patient feel at ease, in order to better understand the stressful situations that led her to her compulsive desire of smoking” | |||||||||
COPD: chronic obstructive pulmonary disease.