Author: Asma Chaabouni.
Symptoms such as pain, fatigue and constipation are part of everyday sensation. For several reasons such as symptoms severity and symptoms persistence, 3.1% of people experiencing symptoms request primary care assistance within 6 weeks of the onset of the symptoms [1]. When these symptoms could not be attributed to well-established diseases, a disease diagnosis label is not appropriate. In this case, symptom diagnosis can be used as a diagnostic label according to the International Classification of Primary Care (ICPC).
A paucity of research explored symptoms as a generic phenomenon in primary care. A cross-sectional study [2] was conducted to describe the prevalence of symptoms when a specific disease diagnosis could not be made in Danish primary care. The authors asked general practitioners (GPs) to answer a questionnaire after each contact with the patient. Subsequently, they linked these data to data of the patients’ primary care electronic health records. Out of all presented health problems, the GPs made a symptom diagnosis in 35.8% of the cases. Symptom diagnoses were most commonly related to musculoskeletal and respiratory systems. Consultations for symptom diagnoses lasted significantly longer than consultations for diseases (13.7 vs 12.9 minutes, p < 0.001). Additionally, GPs reported that these consultations were more challenging than consultations for disease diagnoses. Interestingly, GPs expected that presented symptoms would not result in a future specific disease diagnosis for half of these patients. In fact, given the dominance of the biomedical disease model in western medicine, one might speculate that the GPs would attribute most of the presented symptoms to well-established diseases. To date, there is no evaluation of the course of symptoms in primary care and whether these symptoms evolve into somatic conditions.
In light with these findings, the authors emphasize that GPs should be better equipped in managing patients with symptom diagnoses. As medical training is mainly focused on diseases, GP medical training and primary care research should be more focused on symptoms. Training programmes could emphasize the high frequency of symptoms in primary care and introduce a more holistic approach in managing symptoms by applying the biopsychosocial model. These programmes could be incorporated in the curriculum for the GP training course and in primary care conferences.
Asma Chaabouni is a GP with a background in psychology. She is currently pursuing a PhD in the primary and community care department at the Radboudumc, Nijmegen, the Netherlands.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 956673. The article reflects only the author’s view, the Agency is not responsible for any use that may be made of the information it contains.
