Which Aspects Contribute to Diagnostic Uncertainty in Daily Practice?

DOI: 10.3238/zfa.2015.0392-0398

Ergebnisse einer hausärztlichen Befragung

german translation / full article

Antonius Schneider, Magdalena Wübken, Markus Bühner, Niklas Barth

Keywords: Family Medicine Reason for Encounter Low Prevalence Diagnostic Uncertainty Complexity

Results of a Survey with Family Practitioners

Backgrund: Dealing with diagnostic uncertainty is a core element in family practice. The aim was to identify reasons for encounter, which are often accompanied with uncertainty; and to evaluate sources and context factors for appearance of uncertainty.

Methods: During the development process of a questionnaire, family practitioners (FPs) were asked to describe individual case vignettes. Additionally, they were asked about their attitude towards diagnostic uncertainty and the impact on daily practice. Reasons for encounter were categorized according to ICPC-2. The case vignettes and comments were categorized qualitatively with regard to their content.

Results: 228 FPs participated. The most frequent reason for encounters were abdominal pain (n=58; 25%) and chest pain (n=32; 14%). Eight sources of uncertainty were identified: multi-morbidity, tension between mental and physical reasons, ´clinical picture still not clearly developed´, uncertainty related to a defined clinical problem, non-fitting symptom pattern, multiple complaints, conflicting expert opinions, and failure of therapy. 133 (58%) stated that dealing with uncertainty is a daily issue in general practice.

Conclusions: Uncertainty appeared as immanent in family practice. Reasons and context of uncertainty were very heterogeneous and varied considerably. Continuous medical education activities related to uncertainty in family practice might be helpful to alleviate daily routine. Beyond that, the development of an abdominal pain guideline and accounting for multi-morbidity in guidelines might also be helpful.

(State: 18.11.2015)

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