[Diagnostic approach in primary care - Role of intuition, cognition, clinical data and other determinants]

This prospective observational study evaluated the diagnostic approach followed by 59 GPs of Western Switzerland in 672 patients with chest pain. The approach common for all GP begins with a very rapid assessment of the threat and of the etiology of the condition. This intuitive estimate allows for an analytical process by means of history, physical and, in half of the cases, paraclinical or specialist examination and is influenced by the hazard of the condition, the difficulty of the diagnosis, the concern, the gender, and the personality of both patients and GPs. The final diagnosis is reached in half of cases after the first minutes, in 81% or 94% at the end of consultation or three months later. Clinical data are the most important factor for the diagnosis in primary care but lately paraclinical data are becoming much more important.