General practitioners often turn out to be correct when they suspect serious disease
A new study equates the general practitioner’s (GP) interpretation of signs of serious disease with the classical alarm symptoms which give direct access to fast diagnosis at the hospitals.
How often is the general practitioner correct in his suspicion that the patient is suffering from a serious disease such as cancer – even though the patient does not necessarily demonstrate clear alarm symptoms?
Researchers from the Research Unit for General Practice at Aarhus University have examined this question. A total of 404 Danish GPs and their consultations with 4,518 patients aged 18 years or over formed the basis for the project. The study shows that around six percent of all consultations with a GP lead to a suspicion of the possibility of cancer or another serious disease being present. In other words, 6,000 times each day in Danish general practice.
"The survey indicates that the general practitioner’s suspicion of serious disease is just as good as – or, indeed, even better than - the alarm symptoms that give direct access to a fast diagnosis at the hospitals," says medical doctor and PhD student Peter Hjertholm from Aarhus University’s Research Unit for General Practice.
Half of cancer patients do not present alarm symptoms
Only about half of the patients who get a cancer diagnosis present with classical alarm symptoms such as e.g. blood in their urine, difficulty swallowing or rectal bleeding. Therefore, it is well known that fast and easy access to examinations at the hospitals is an important tool in the fight to diagnose serious diseases as early as possible.
In other words, there is a large group of patients with serious diseases that need to be identified by the GPs with the aid of other signals than the well-known alarm symptoms.
“What our figures show is that there are good reasons for taking the general practitioner’s suspicion of serious disease seriously. Because when the GP stated that the patient could have a serious disease there was actually a ten percent probability that the patient will receive a serious diagnosis within the next two months. By comparison, the risk of colorectal cancer being diagnosed after rectal bleeding is around five percent," says Peter Hjertholm.
"So our study shows how important it is to support the primary diagnosis in cases where the GP suspects there is serious disease, so that this suspicion makes it possible to send patients directly to ultrasound and endoscopic examinations on an equal footing with specific alarm symptoms."
Facts:
- Read the article ”Predictive values of GP's suspicion of serious disease: a population-based follow-up study”, published in The British Journal of General Practice.
- The researchers have used both available registers and questionnaires in the study.
- The study follows all patients for six months.
- The general practitioners suspect serious disease in 5.7 percent of all consultations.
- If the doctor suspects serious disease, the patient’s risk of contracting a new serious disorder within two months was three times higher than if the GP did not suspect anything. Similarly, the risk of being diagnosed with cancer was eight times higher.
- Patients where the doctor suspected serious disease were referred for diagnostic examinations four times as often as patients where there was no suspicion of serious disease.
Further information:
PhD student, MD Peter Hjertholm
Aarhus University, Department of Public Health
Research Unit for General Practice
Direct tel.: +45 8716 8043
Mobile: +45 4041 4454
Professor, PhD Peter Vedsted
Aarhus University, Department of Public Health
Research Unit for General Practice
Direct tel.: +45 8716 7905
Mobile:+45 2083 8259