Diagnosis and general practice.

This discussion paper presents the case for a rigorous diagnostic research agenda within primary care. In view of unique aspects of primary care medicine and the relatively unselected nature of the populations encountered by general practitioners, it is clear that diagnostic research undertaken in other settings may be inapplicable. Most diagnostic studies adopt designs that seek to compare items, or clusters of items, of clinical information against a gold standard. In order to enhance the feasibility and rigour of such research within primary care, suggestions are made about priorities and specific key methodological issues. It is essential that the information generated by primary care diagnostic research should be reliable, valid, useful, and useable within general practice. The ultimate objective must be the identification of specific items, or small clusters of items, of clinical information of high discriminant ability among the groups of patients encountered in general practice.