Family Practice Advance Access published online on October 29, 2007
Family Practice, doi:10.1093/fampra/cmm053
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Different from what the textbooks say: how GPs diagnose coronary heart disease
a Department of General Practice/Family Medicine, University of Marburg, Germany
b Department of General Practice, Family Medicine and Prevention, Paracelsus Medical University of Salzburg, Austria
c Centre for Primary Health Care Studies, University of Warwick, Coventry, UK
Correspondence to Maren Abu Hani, Department of General Practice/Family Medicine, University of Marburg, D-35032 Marburg, Germany; Email: abuhani{at}med.uni-marburg.de
Received 28 June 2007; Accepted 12 July 2007.
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Abstract |
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Background. In patients with chest pain, GPs have to identify those with coronary heart disease (CHD) to arrange for further investigation and treatment. Previous studies have shown that only between 8% and 18% of patients have CHD.
In primary care, the history is the most important diagnostic tool. However, there are only few studies exploring diagnostic criteria that GPs actually use in their daily practice.
Objective. To identify GPs' diagnostic criteria for diagnosing CHD in patients with chest pain.
Methods. In a semi-structured interview, 23 GPs were asked to describe their individual diagnostic criteria in two of their patients with chest pain they had prospectively identified. Interview data were taped, transcribed and analysed qualitatively.
Results. Histories of 39 patients were described, of which 17 patients were thought to have CHD and/or an indication for an emergency hospital admission. GPs mentioned the person-specific discrepancy, that is differences in behaviour or a different appearance of a patient in comparison to previous consultations, as an important diagnostic criterion. Known risk factors for CHD and past illness behaviour also influenced the GPs' diagnoses.
Conclusion. Apart from classical textbook criteria, GPs make use of their prior knowledge of individual patients in a specific way. Discrepancies between previous and actual consultations alert the GPs for serious diseases. At the primary care level, medical practitioners use criteria that differ from secondary or tertiary care.
Keywords. Chest pain, diagnosis, family practice, judgement, myocardial ischaemia.
Abu Hani M, Keller H, Vandenesch J, Sönnichsen AC, Griffiths F and Donner-Banzhoff N. Different from what the textbooks say: how GPs diagnose coronary heart disease. Family Practice 2007; Pages 1–6 of 6.