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Are patients' chief complaints generally specific to one organ system?
A B Fleischer1, E F Gardner, S R Feldman
1Westwood-Squibb Center for Dermatology Research, Departments of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA. afleisch@wfubmc.edu
Background:
The coordinator of care function is one of the most important roles played by primary care physicians. This role is essential for efficient delivery of healthcare to patients with unfocused medical problems.
Objectives:
To identify which chief complaints are unfocused and to determine how often visits to office-based physicians are for unfocused chief complaints.
Study Design:
Retrospective review of National Ambulatory Medical Care Survey data.
Methods:
We defined an unfocused chief complaint as one for which fewer than 95% of the office visits for the top 10 diagnoses associated with that chief complaint were related to a single organ system or specialty area. We analyzed data from the 1990-1994 National Ambulatory Medical Care Survey to determine the frequency of new patient visits to physicians for different chief complaints and to determine the frequency with which common chief complaints yield diagnoses in a single organ system.
Results:
The 3 most common chief complaints in each of 12 symptom categories accounted for 80 million (32%) of the 250 million new patient office visits made during the survey period. Unfocused conditions accounted for 26% of visits for these chief complaints. The unfocused chief complaints included musculoskeletal conditions (back pain, knee pain, low back pain), mental/nervous system conditions (anxiety/nervousness, smoking problems, headaches, vertigo/dizziness), abnormal pulsations, swollen glands, and abdominal pain.
Conclusions:
Patients' chief complaints and the resulting diagnoses are often within the same organ system. We found that a coordinator of care role for primary care physicians is appropriate for common neurologic, rheumatologic, and general complaints. A coordinator of care is not needed for specific specialty areas, including ophthalmology, dermatology, obstetrics/gynecology, urology, and otolaryngology, because patients typically can accurately self-refer to these specialists. Our study did not address reasons to use primary care physicians as coordinators of care, such as preventive care, patient preference, or cost effectiveness of care.