The cardiologist and the staff at hospital reinforced the importance of attending as soon as possible, and, since this incident a decade ago (which resulted in a bypass), the patient

felt that “as far as my heart’s concerned, there never is any hesitation anymore”: You realise that the support is there and you must use it to put your mind Verteporfin at rest because there’s nothing worse than something festering and you sit here and you worry about it and you think about it, when you know for a fact that the support’s there, so don’t hesitate, just [go to hospital], that’s what the people [at the hospital] are there for. An episode in the six months prior to interview illustrated this point. He experienced palpitations which he described as “quite concerning. It wasn’t necessarily painful, but because of this pounding in my chest I, I was a bit concerned about it”. He called an ambulance immediately: Because of the previous heart [problems], Trichostatin A clinical trial I know it was ten, eleven years ago, but, I get very anxious when things start to happen with my heart and I like to get it seen to straightaway.

Patients differentiated between routine primary care and EC services according to what they offered. Patients valued routine primary care as a source of personal relationships with practitioners: I generally stick to one [GP] because he like gets to know your background and all your history and everything else, you know (…) but sometimes, like I said to you I just think what else can they do for me? (P27, female, 54 yrs, asthma & COPD) Conversely, they valued EC services for their technological

expertise, perceiving this to be unavailable in primary care: They won’t do x-ray there [at the GP surgery], they won’t do, they’ll give you tablets. If I go to A&E they get everything there, everything to take blood, to take wee [urine], and then it’s sort me out there (P07, female, 44 yrs, diabetes) At times of urgent Celastrol need, patients preferentially sought technological expertise. This often resulted in using EDs, but a few patients valued – and used – other services because of their perceived technological, and often disease-specific, expertise, as established in prior instances of help-seeking: Researcher: [If] you were getting really bad, um what do you think’s the first thing you would do? Previous experiences of services established this belief that routine primary care was not the best site for disease-specific care: My GP is a wonderful GP, but he’s not geared to look after diabetics (…) The GP’s a general practitioner, he knows an awful lot about a lot of things, but the diabetic clinic are specialists for that disease (P44, female, 54 yrs, diabetes) Conversely, experience of services that were responsive and technologically capable informed future help-seeking, as illustrated by Box 2.