Diagnostic Procedures in Primary Care Patients With Leg Edema – a Qualitative Study
DOI: 10.3238/zfa.2014.0391-0397german translation / full article
Background: The symptom uni- or bilateral leg oedema represents a broad range of possible underlying aetiologies. The background of leg oedema is multifactorial and usually the GP is the first contact point for patients presenting with this symptom. We aimed to identify GPs’ diagnostic approaches in patients presenting with leg oedema.
Method: Interviews with 15 GPs (20–30 minutes) using a semi-structured interview-guideline were conducted. GPs described their individual diagnostic strategies concerning all patients presenting with leg oedema they had prospectively identified during the previous four weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.
Results: First impression of the patient together with knowledge of the past history plays an important role in the workup of patients with leg oedema. Individualised approaches to history taking and clinical examination are the cornerstones of diagnosis, the value und contribution of further technical examinations are judged differently by GPs. Collegial feedback and patient referral are the main strategies used by GPs to reduce diagnostic uncertainty.
Conclusion: Further research in regard to diagnostic accuracy of symptoms and signs for patients with leg oedema is necessary. Results of this research should be incorporated in future guidelines.