The course and management of symptom diagnoses in general practice

In general practice, symptom diagnoses are commonly used when patients seek care for symptoms in which no specific disease or disorder can be diagnosed. These diagnoses are prevalent, yet little is known about how they evolve or how General Practitioners (GPs) manage them in daily practice.

To explore the course of symptom diagnoses and compare GPs' management strategies, both for symptom diagnoses that persisted for more than a year or changed into disease diagnoses.

A retrospective longitudinal cohort study was conducted using the Dutch Family Medicine Network (FaMe-Net) database. We included all episodes of care in which the diagnosis recorded at the first consultation was coded as a symptom diagnosis between 2008 and 2021. The course of each EoC was analyzed, comparing management strategies, such as GP contacts, interventions, referrals, and medication use, between symptom diagnoses that persisted and those that changed into disease diagnoses. Referrals to primary healthcare workers include referrals to nurses, social workers and therapists such as physiotherapists and occupational therapists.

Out of the 12,532 EoC that started as symptom diagnoses, 9.4% changed into a disease diagnosis within a median of 22 days [2-239], 85.8% resolved within one year, and 4.3% persisted as symptom diagnoses. Within the course of the first year of care, a significantly higher number of management strategies were found for EoC that changed into a disease diagnosis. Referrals to primary healthcare workers were lower for EoC that changed into disease diagnoses (OR = 0.80, 95% CI [0.74, 0.87], p < 0.001).

Symptom diagnoses are more likely to resolve within a year, and only a few will persist or change into disease diagnoses. GPs can rapidly diagnose diseases. Our findings highlight the importance of reassurance in patient care when discussing the prognosis of symptom diagnoses, as most of these symptoms tend to resolve.