'My first thoughts are…': a Framework Method analysis of UK general practice healthcare professionals' internal dialogue and clinical reasoning processes when seeing patients living with obesity in primary care.

Objectives: To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity.

Design: This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient.

Setting: Interviews were conducted remotely via Skype between August and September 2019.

Participants: A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners).

Results: Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs' assumptions around patients' lifestyles, occupations and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments.

Conclusions: While it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.