Diagnostic work in general practice: more than naming a disease

Abstract

Objective: To explore the medically unexplained disorders by examining endpoints of irresolute diagnostic strategies.

Design: Qualitative observational study based on audio-taped general practice consultations, editing analysis style inspired by Giorgi's phenomenological approach.

Setting: Primary health care.

Subjects: Purposeful sampling of 17 consultations containing diagnostic conclusions, but no clear-cut diagnosis drawn from a total of 86 consultations with women patients in general practice.

Main outcome measures: Descriptions of diagnostic conclusions in consultations when clear-cut diagnoses are not obtained.

Results: We identified three types of diagnostic conclusions. The first conveys assurances that nothing dangerous is suspected. The doctors find that the symptoms somehow look like a diagnosis, and further investigation can be initiated. In the second group, the symptoms lead the doctors to test management, and take the outcome as material for further assessment. The third type of conclusion implies a decision to track cues of potential danger, quick settlements, although the seriousness of the situation is not necessarily communicated to the patient.

Conclusion: Exploration of diagnostic work in general practice can provide access to understand what goes on when patients are given the label of "unexplained" disorders.