Michiels-Corsten Matthias, Bösner Stefan, Donner-Banzhoff Norbert
Department of General Practice/Family Medicine, Faculty of Medicine, University of Marburg, Marburg, Germany.
Br J Gen Pract. 2017 May;67(658):e361-e369. doi: 10.3399/bjgp17X690509. Epub 2017 Apr 10.
One of the tenets of general practice is that continuity of care has a beneficial effect on patient care. However, little is known about how continuity can have an impact on the diagnostic reasoning of GPs.
To explore GPs' diagnostic strategies by examining GPs' reflections on their patients' individual thresholds for seeking medical attention, how they arrive at their estimations, and which conclusions they draw.
Qualitative study with 12 GPs in urban and rural practices in Germany.
After each patient consultation GPs were asked to reflect on their diagnostic reasoning for that particular case. Qualitative and quantitative analyses of consultations and interview content were undertaken.
A total of 295 primary care consultations were recorded, 134 of which contained at least one diagnostic episode. When elaborating on known patients, GPs frequently commented on how 'early' or 'late' in an illness progression a patient tended to consult. The probability of serious disease was accordingly regarded as high or low. This influenced GPs' behaviour regarding further investigations or referrals, as well as reassurance and watchful waiting. GPs' explanations for a patient's utilisation threshold comprised medical history, the patient's characteristics, family background, the media, and external circumstances.
The concept of an individual threshold for the utilisation of primary care would explain how GPs use their knowledge of individual patients and their previous help-seeking behaviour for their diagnostic decision making. Whether the assumption behind this concept is valid, and whether its use improves diagnostic accuracy, remains to be investigated.
全科医疗的原则之一是连续性照护对患者护理有有益影响。然而，关于连续性如何影响全科医生的诊断推理，我们知之甚少。
通过考察全科医生对患者寻求医疗帮助的个体阈值的思考、他们如何得出估计以及得出哪些结论，来探索全科医生的诊断策略。
对德国城乡诊所的12名全科医生进行的定性研究。
在每次患者会诊后，要求全科医生反思该特定病例的诊断推理。对会诊和访谈内容进行定性和定量分析。
共记录了295次初级保健会诊，其中134次至少包含一个诊断过程。在阐述已知患者时，全科医生经常会评论患者在疾病进展过程中倾向于“早”或“晚”就诊的情况。相应地，严重疾病的可能性被认为是高或低。这影响了全科医生在进一步检查或转诊、安慰以及观察等待方面的行为。全科医生对患者就诊阈值的解释包括病史、患者特征、家庭背景、媒体和外部环境。
初级保健利用的个体阈值概念可以解释全科医生如何利用他们对个体患者及其先前寻求帮助行为的了解来进行诊断决策。这一概念背后的假设是否有效，以及其使用是否能提高诊断准确性，仍有待研究。
