Diagnostisches Vorgehen bei Patienten mit Beinödemen in der Hausarztpraxis - Eine Qualitative Untersuchung

Leg oedemas represent a classic area of research in family medicine. Usually, a general practitioner (GP) is the first contact point for patients presenting with this symptom while causes are often multifactorial. Therefore, diagnostic workup and differentiation between causes are described as the GP’s most important tasks when confronted with patients presenting with leg oedema. Being a typical early symptom for various diseases, it has been shown that leg oedemas are given a great deal of attention in GPs’ differential diagnosis. However, existing evidence on GPs’ diagnostic approaches regarding patients presenting with leg oedemas is sparse. For the present qualitative study, we conducted interviews with fifteen GPs about their individual diagnostic approaches regarding leg oedemas, using a semi-structured interview guideline. Interviews concerned patients presenting with leg oedemas during the previous four weeks. The interviews were taped and transcribed verbatim, and a qualitative analysis was then conducted by two independent raters. The results show that history taking and clinical examination are the cornerstones of diagnosis of the interviewed GPs. Regarding their early diagnostic hypotheses, the first impression of the patient together with knowledge of the past history plays an important role. In contrast, further technical examinations (such as laboratory tests, sonography, etc.) are mostly of minor importance for the interviewed GPs. Furthermore, we find that the interviewed GPs used a broad variety of heuristics and diagnostic strategies in order to include or exclude potential diagnoses. Also, cognitive processes such as intuition, experience, and “gut feeling” play a decisive role. The main strategies used by the interviewed GPs to reduce diagnostic uncertainty are collegial feedback and patient referral. In conclusion, the present study provides rich evidence about the current status of health care regarding the diagnostic workup of patients who approach GPs with leg oedemas. The results warrant further research such as symptom evaluating studies on the diagnostic success of history taking and clinical examination regarding the underlying aetiologies. Results of this research should be incorporated in future guidelines.