Diagnostic protocols—A consultation tool still to be discovered

Abstract

RationaleExperienced primary care physicians handle most illnesses to everyone's satisfaction despite limited resources of time and means. However, cases can be multifaceted in that harmless‐presenting symptoms may also be warning signals or an indicator of a health disorder that too infrequently presents in family practice to be diagnosed correctly. On the basis of these observations, RN Braun developed 82 diagnostic protocols for a structured recording of various complaints.MethodAll consultations during the years 2001 to 2014, in which 1 author (WF) had used diagnostic protocols in her single‐handed practice, were analyzed retrospectively regarding reasons for encounter, diagnostic classification, and long‐term outcome.ResultsDuring the period, a diagnostic protocol was used 1686 times. It was applied at a rate of approximately 5% of 2500 new complaints annually, most often (1366 times) for febrile conditions. In 320 consultations for other complaints, 43 different diagnostic protocols were applied. Among them, the “tabula diagnostica” for various undifferentiated symptoms was used most frequently (n = 54), followed by diagnostic protocols for headache (n = 45), dizziness (n = 36), precordial pain (n = 20), nonspecific abdominal pain (n = 15), low back pain (n = 14), hypertension (n = 12), diarrhea > 1 week (n = 12), epigastralgia (n = 11), depression (n = 10), polyarthralgia (n = 8), cough, and lower abdominal pain (each n = 7). A final diagnosis was established in less than 20% of cases.ConclusionsThis observational study from routine practice gives an insight how diagnostic protocols helped to manage complex patient presentations. A broader use of diagnostic protocols could investigate the potential of this consultation tool to handle the complexity of primary health care. The use of a standardized diagnostic approach could stimulate research, in particular on managing common complaints/undifferentiated illness and their inherent diagnostic uncertainty.

A Digital Communication Assistance Tool (DCAT) to Obtain Medical History from Foreign-Language Patients: Development and Pilot Testing in a Primary Health Care Center for Refugees

“…The discursive development process involved experienced GPs, programmers, cultural scientists, sociologists, user interface (UX) designers, and numerous translators. The first step of the development process was to create a query algorithm based largely on an approach developed by Braun, a physician who used 82 diagnostic protocols to thoroughly record various health complaints [21,22]. A team of experienced GPs identified areas of Braun's diagnostic protocols that could be obtained by asking the patient directly, without having to conduct a clinical examination or other medical tests.…”

Establishing a Novel Diagnostic Framework Using Handheld Point-of-Care Focused-Echocardiography (HoPE) for Acute Left-Sided Cardiac Valve Emergencies: A Bayesian Approach for Emergency Physicians in Resource-Limited Settings

“…The use of standardised diagnostic pathways and protocols that incorporate POCUS can significantly enhance the effectiveness and reliability of acute patient care [42]. These protocols not only provide a clear and structured learning pathway for clinicians, but also foster efficient documentation and communication of findings among health care provider, thereby elevating the overall quality of patient care and safety [39].…”

Complex adaptive systems approaches in health care—A slow but real emergence?

“…Primary care, because of its diversity and variability, scores highly on the amount of work demanded of its practitioners. In this theme, Fink et al describe the application of a clinical tool—Diagnostic Protocols (DP)—in a single handed practice over a 14‐year period. Based on several decades of work by Braun and colleagues, DP represents a series of simple rules to reduce uncertainty in primary care presentations of serious conditions that may seem at first contact to be routine and non‐serious.…”