Int J Family Med Prim Care | Volume 1, Issue 2 | Research Article | Open Access
Verdon F
Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
Fulltext PDFObjective: Analyses on the spot the principal determinants of diagnostic process in primary care. Materials and Methods: In a multicenter observational study, 59 experienced GP evaluated the potential threat of the clinical condition and their diagnostic hypotheses in 672 consecutive patients with chest pain during the initial consultation, after three months and after one year. Result: The diagnostic procedure was consistent from a GP to another, and started immediately during the consultation. One or two min after the identification of chest pain, the GP proposed diagnostic hypotheses for 70% of the patients and offered an assessment of the potential danger for 85% of them. The clinical status assessed as potentially dangerous led to an aggressive diagnostic strategy. The initial impression was often modified subsequently so that the final diagnosis was reached in 51% of cases after one to two min, in 81% at the end of the consultation and in 97% after one year. The difficulty of diagnosis and the degree of anxiety of the patients and GPs delayed the diagnostic. Irrational factors such as personality, anxiety or gender of the physician and of the patient influenced the approach. This one seems linked to an intellectual endeavor appeared very early in the evolution. Conclusion: In primary care, the diagnostic process quickly starts with the assessment of risk associated with the condition and the laying of first diagnostic hypothesis. This intuitive process is followed by an analytical activity based on clinical and, if necessary, paraclinical data. It is mainly founded on the clinic.
Paraclinical; General practitioners; Ambulatory
Verdon F. Diagnostic Approach in Ambulatory Medicine. Int J Fam Med Prim Care. 2020; 1(2): 1007.