Table 3 Typical account of surgeons presenting detailed information on technique, and lists of risks, with minimal patient interaction. Patient utterances indicated in square brackets

“All the tests suggest- you know, show this tumour in the lower oesophagus – there’s no obvious spread, as w- far as we can tell, to anywhere else in the body, so it’s confined to the lower oesophagus and perhaps the local lymph nodes. [Mm hm] Those get removed with surgery but involved lymph nodes is a worse, ultimate sign than if you didn’t have lymph nodes involved but only time will tell whether you’re lucky or you’re not.

The surgical treatment involves removing the tumour and the oesophagus, so if this is the- if the tumour’s at the bottom of your oesophagus, we have to remove enough of the tumour- enough of the oesophagus for the stomach below to get- well, get it all out and then you’re left with a gap which, to be able to eat again, has to be put back together and what we do is we make a tube out of your stomach, like- freeing up the top bit of your stomach [Mm] and then that bit of the stomach is brought up into the chest to join onto the oesophagus, there, so it ends up looking a bit like this, so you’re diaphragm is here but your stomach is pulled up into your chest [Mm]. So, the operation involves an abdominal bit where we disconnect the top of your stomach from what’s attaching it in there, the bottom bit of the stomach stays where it is. We then turn you onto your side and go through your chest, collapse the lung so that we can see what we’re doing and then re-inflate the lung at the end of the operation and then pull the stomach up, make a tube out of it and join it to your oesophagus. So, that’s the technical side of the operation

The bit that, er, causes the complication- well, it’s the complications afterwards that are- [Mm Mm] that are the what the potential problems and big operations have several complications – you can get chest infections, wound infections, you can get, er, bleeding, you can get heart problems, you can get, er, if that join we make leaks, that’s a serious complication [Mm], if the blood supply to the top of this bit of stomach’s not enough and then it dies, that’s a serious complication [Mm]- it clots in the legs. There are a whole range of things that are possible, the major it- you know, the majority of the people get through the surgery [Mm], erm and leave hospital so our mortality rate – the chance of dying in hospital from a serious complication is less than two percent, or around two percent [tut], so a ninety-eight percent chance of getting through major surgery [Mm]

(Consultation with IS009)