van der Weijden Trudy, van Velsen Monique, Dinant Geert-Jan, van Hasselt Cathelijne M, Grol Richard
Centre of Quality of Care Research, Institute for Extramural and Transmural Research, Department of General Practice, Maastricht University, The Netherlands.
Med Decis Making. 2003 May-Jun;23(3):226-31. doi: 10.1177/0272989X03023003004.
To gain insight into general practitioners' (GPs) test-ordering behavior for patients presenting with unexplained complaints. An unexplained complaint's symptoms are not alarming, and there is no plausible medical or psychosocial explanation for it. The Dutch College of General Practitioners (DCGP) recommends a watchful, waiting attitude for test ordering for unexplained complaints.
Observational, cross-sectional study of 567 doctor-patient consultations performed by 21 GPs.
On average, 13% of consultations involved complaints considered unexplained by GPs. Unexplained complaints were positively related to test ordering (adjusted odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.1-5.3), despite the DCGP's recommendation. Patients' expectations about testing influenced test ordering even more (adjusted OR = 4.1, 95% CI 2.2-7.6).
Unexplained complaints happen daily in general practice. Besides the DCGP's recommendation, factors such as GPs' desire to understand complaints and patients' expectations seem to have impacts. Guideline development and quality improvement projects should respect, next to Bayesian rules, GP- and patient-related determinants of test ordering.
深入了解全科医生（GP）对出现不明原因症状患者的检查开单行为。不明原因症状并不令人担忧，且对此没有合理的医学或社会心理解释。荷兰全科医生学院（DCGP）建议对不明原因症状采取谨慎观察、等待的检查开单态度。
对21名全科医生进行的567次医患咨询进行观察性横断面研究。
平均而言，13%的咨询涉及全科医生认为原因不明的症状。尽管有DCGP的建议，但不明原因症状与检查开单呈正相关（调整后的优势比[OR]=2.4，95%置信区间[CI]1.1 - 5.3）。患者对检查的期望对检查开单的影响更大（调整后的OR = 4.1，95%CI 2.2 - 7.6）。
在全科医疗中，不明原因症状每天都会出现。除了DCGP的建议外，诸如全科医生理解症状的意愿和患者期望等因素似乎也有影响。除了贝叶斯规则外，指南制定和质量改进项目在制定时应考虑与全科医生和患者相关的检查开单决定因素。
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