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Unexplained complaints in general practice: prevalence, patients' expectations, and professionals' test-ordering
Trudy van der Weijden1, Monique van Velsen, Geert-Jan Dinant
1Centre of Quality of Care Research, Institute for Extramural and Transmural Research, Department of General Practice, Maastricht University, The Netherlands. trudy.vanderweijden@hag.unimass.nl
Summary
General practitioners (GPs) frequently encounter unexplained complaints. Despite guidelines, GPs order tests for these cases, influenced by patient expectations and a desire to understand symptoms.
Area of Science:
- General Practice
- Diagnostic Decision-Making
- Health Services Research
Background:
- Unexplained complaints are common in primary care, presenting diagnostic challenges.
- The Dutch College of General Practitioners (DCGP) advises a conservative approach to test ordering for such cases.
- Understanding factors influencing general practitioners' (GPs) test-ordering behavior is crucial for guideline development.
Purpose of the Study:
- To investigate the test-ordering behavior of GPs when faced with patients presenting with unexplained complaints.
- To identify factors associated with test ordering in the context of unexplained complaints in general practice.
Main Methods:
- An observational, cross-sectional study design was employed.
- Data were collected from 567 doctor-patient consultations involving 21 GPs.
- Statistical analysis, including adjusted odds ratios, was used to assess relationships.
Main Results:
- Approximately 13% of consultations involved unexplained complaints as identified by GPs.
- Unexplained complaints were significantly associated with increased test ordering (aOR = 2.4).
- Patient expectations regarding testing had a stronger influence on test ordering (aOR = 4.1) than the presence of unexplained complaints alone.
Conclusions:
- Unexplained complaints are a daily occurrence in general practice, necessitating careful management.
- Test ordering decisions are influenced by factors beyond clinical guidelines, including physician curiosity and patient expectations.
- Future guideline development and quality improvement initiatives should incorporate both clinical reasoning (Bayesian rules) and patient- and physician-centered factors influencing test ordering.