Diagnostic strategies used in primary care

Abstract

The strategies used by general practitioners in making a diagnosis are being formally recognised; this article is the first in a series that will illustrate their application, and is accompanied by a case study (doi:)

Diagnosing headache in primary care: a qualitative study of GPs’ approaches

“…The timeefficiency principle is considered a core diagnostic strategy in low-prevalence settings, and safely as well as efficiently reduces the number of patients who need to be formally tested to make a correct or specific diagnosis for a given person. 26,27 In dealing with diagnostic uncertainty, all GPs screened their patients for certain red flags and some of the GPs applied the familiarity heuristic. The aforementioned red flags largely corresponded with warning signs for secondary headache mentioned in guidelines.…”

Diagnostic safety-netting

“…3 Up to 50% of patients will not have a firm diagnosis at the end of a consultation with their GP and yet the need to rule out serious illness remains. 4 Safetynetting is critically important in this situation. It is also critically important if the diagnosis is known but carries a significant risk of serious complications either in itself (for example, dehydration in gastroenteritis) or because the individual characteristics of the patient put them at particularly high risk of complications (for example, they have significant comorbidity or are having treatment which reduces their immune system).…”

“…4 Often these strategies 'buy time' for the condition to either resolve or declare itself more floridly. What is not…”

How do general practitioners use ‘safety netting’ in acutely ill children?

“…Buntinx et al suggest four strategies to deal with diagnostic uncertainty: the GP's gut feeling, the use of diagnostic algorithms, planning additional tests, and the use of 'safety netting' (1)(2)(3)(4)5).…”