Comparison with existing literature
obesity, anxiety, breathlessness, ill, weight loss
OBESITY, DISEASE
As in this study, others have found that breathlessness is likely to be identified by clinicians when patients are seeking help for a different problem, thus increasing the complexity of patient assessment in an already time-limited appointment.The incremental approach to investigation to rule out individual diagnoses described by clinicians may be due to disease-specific guidelines that promote excluding a particular diagnosis, rather than a holistic approach to find all causes of a symptom.There are multiple causes of, and contributing factors to, breathlessness, which may be missed when a single disease diagnostic algorithm is used. The current study highlights the tension between performing extensive investigations in every patient to find a diagnosis rapidly versus patient burden, and overuse and cost; some investigations may also have a level of harm involved.Clinicians described challenges when a disease label was not identified, feeling ill prepared to offer advice or be definitive about weight, deconditioning, and anxiety as causes of breathlessness. These causes were considered less acceptable as a positive or confirmed diagnosis to both clinicians and patients. However, consideration of the definition of a diagnosis: Several quotes in this study demonstrate that clinicians and patients recognised that deconditioning and obesity were important factors contributing to breathlessness. Opportunistic behaviour change interventions, such as smoking cessation, increased physical activity, and weight loss, are advocated in healthcare settings; however, a lack of time and perceived lack of clinician skills and patient motivation are known barriers.