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Table 3 Reassuring core cognitions and supporting factors

From: “Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

Reassuring core cognitions Factors supporting reassuring core cognitions
Consultation-specific factors. My doctor: Context-specific factors. There is:
I feel safe and supported because I have a trusting relationship with my doctor. - emphasizes the equality of our relationship by: approaching me in a friendly manner, using humour. - an existing trusting doctor-patient relationship based on: the duration of the relationship; I know I can always ask the doctor any question I have; the doctor being always open and honest.
- shows that he/she is interested in me as a person by: allowing me to tell my story, listening attentively, exploring and understanding my feelings and personal situation.
- shows involvement by: showing empathy; monitoring my condition
I trust my doctor’s judgment since I trust his/her expertise. - obtains a good understanding of my problems and symptoms by: allowing me to tell my story; listening attentively; exploring and summarizing my symptoms/feelings/context; showing/telling me what he/she is typing; referring to the previous consultation. - an experienced doctor who: has had many years of experience; sees many patients with problems that are similar to mine; has a good reputation in my neighbourhood.
- takes the necessary actions to adequately investigate my symptoms by: exploring alarming symptoms; performing a physical examination and other investigations; referring me to a specialist. - a familiar doctor who: knows my whole history.
- explains the reasons for his/her actions by: announcing and explaining what he/she will do during the physical examination and which further investigations will be done. - a careful doctor who: has never made a mistake; has always been quick and effective; has always referred me when it was necessary.
- takes care to perform actions properly and thoroughly by: making sure that he/she does not forget anything by sharing findings with me during the examination/when typing during the consultation; discussing test results with me; proposing a good specialist.
I do not have a serious disease - underpins why my symptoms are not serious by: explaining (using visual tools) why my symptoms/findings are not consistent with a serious diagnosis; demonstrating how the examination excludes a serious diagnosis; emphasizing that the maximum amount of information has been obtained; pointing out that a specialist will make the same diagnosis. - sufficient evidence provided to exclude a serious diagnosis because: multiple examinations, investigations and medical professionals have excluded serious disease.
- enables me to reassure myself by: exploring alarming symptoms that are not present; ordering tests and investigations of which I can interpret the results.
- underlines (non-)verbally that my symptoms are not serious by: a calm and unconcerned expression; stating that I do not have a serious illness/there is no need to worry/my symptoms are benign.
- shows that actions that might indicate a serious diagnosis are not really necessary by: stating there is no need for illness behaviour; not referring urgently; emphasizing that the purpose of the referral is to re-assure me.
- provides insight into my tendency to worry about physical symptoms by: giving a cause for this tendency that I can recognize and understand, emphasizing the importance of being aware of this tendency.
My health problem is harmless/easy to treat. - gives a logical and understandable explanation for my symptoms by: explaining what causes them; giving an explanation that is consistent with my self-image; linking new symptoms to a benign diagnosis on which we had agreed.  
- clarifies the cause of my symptoms by: using clear language; talking slowly; checking that I have fully understood the benign diagnosis; using visual tools; sharing findings during the physical examination.
My health problem will: disappear/not return/not deteriorate - ensures I receive adequate treatment by: tailoring the treatment to my wishes and expectations; proposing treatment that I can execute myself; treating the cause of my symptoms; referring me to (a team of) specialists for treatment - evidence that I am getting better because: the symptoms are diminishing, the treatment is effective.
- adequately monitors my condition by: indicating when he/she wants to schedule a follow-up visit/check-up; monitoring my condition him/herself. - a doctor who always carefully monitors my condition by: scheduling regular follow-up visits; being available in case of problems between appointments.
- gives a positive vision of my future by: outlining the natural course of the disease; emphasizing that everything will be done to ensure a full recovery.