Diagnostische Entscheidungsfindung bei Patienten mit dem Beratungsanlass Bauchschmerz in der Hausarztpraxis

Introduction The symptom „abdominal pain“ is one of the most common reasons for consultations in general practice. It is a complex clinical picture with varying symptoms and a wide spec- trum of possible differential diagnoses. Underlying causes can range from acute and life- threatening to trivial and self-limited. One task of general physicians is to recognise pa- tients with avoidable life-threatening conditions that require immediate intervention in an unselected inhomogeneous collective. The diagnostic decision-making of general prac- titioners during a consultation is influenced by various factors. Detailed diagnostic guide- lines regarding the management of patients with abdominal pain in primary care are missing. The aim of this study was to identify criteria that influence general practitioners in the diagnostic decision-making process in patients with acute or chronic abdominal pain. Methods In a qualitative study, semi-structured interviews with 14 general practitioners were per- formed. Based on a true case of abdominal pain information was collected regarding patient specific factors, symptom characteristics and underlying diseases as well as overarching criteria. The interviews were recorded on tape, afterwards anonymised and transcribed. Subsequently the transcripts were analysed based on Mayring’s techniques of qualitative content analysis. Results Eleven main-criteria affecting diagnostic decision-making were identified. These were the following: (1) the physician’s initial perception of the illness severity; (2) patient presentation; (3) physician’s underlying knowledge about this particular patient; (4) the patient’s medical history; (5) physical examination findings; (6) the limits and (7) the un- certainty in general practice; (8) patient expectations; (9) previous experience with simi- lar cases; (10) fears and concerns of general practitioners and (11) the physician’s „gut feeling“. Discussion It appeared that all information gathered during a consultation along with empirical val- ues affect the physician’s gut feeling. It thus plays a key role in the diagnostic decision- making process. So far only few studies deal with the complex symptom of abdominal pain in primary care. Prospects A prospective diagnostic follow-up study could revise the results of this survey concern- ing their validity. The findings of both studies could form the foundation for the develop- ment of a guideline to make diagnostic decision-making in patients with the chief com- plaint „abdominal pain“ in primary care more accurate and efficient.