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
Total65% (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
“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”
“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 trust55%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 discomfort5%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 responsibility40%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
“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”
“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”
“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.