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Article History

Received: 22 February 2024

Accepted: 12 June 2025

First Online: 1 July 2025

Competing interests

: The authors declare no competing interests.

: The ethical application was approved by the Ethical Committee of the School of Basic Medical Sciences, Shandong University. It adhered to the Declaration of Helsinki and the University’s principles and research guidelines. The committee approved the project and assigned it the reference number ESCBMSSDU2019-1-056. Approval body: Ethical Committee of the School of Basic Medical Sciences, Shandong University. Date of approval: 10/12/2019. Scope of approval: Humanities and Social Sciences.

: Written informed consent was obtained from all participants. Prior to the consultation, the assistant informed patients that their conversations would be recorded for academic research and provided them with consent forms. The consent form included a statement specifying that the recordings were solely for research purposes, that the audio would be specially processed and anonymized to protect the participants’ identities, and that it outlined the purpose of the research, participation, potential risks, data usage, and consent to publication. Patients were also informed that their decision to consent to the recording was entirely voluntary and that the doctor would not alter the treatment based on whether the patient agreed to the recording. If the patient consented to being recorded and signed the consent form, the assistant would activate the recording device, and the doctor would proceed with the consultation. If the patient declined, the assistant would refrain from using the recording device, and the doctor would proceed with the consultation as usual. The recording period lasted from February 2021 to September 2021. All participants voluntarily participated in the research and signed the consent forms. The submission does not include any identifying information or images.