The Probability of Specific Diagnoses for Patients Presenting with Common Symptoms to Dutch Family Physicians

The RFE “tiredness” (Table 3) was associated with several common diseases, but a much wider range of clinical possibilities is apparent. Quite often, this RFE resulted in the symptom diagnosis “tiredness.” Major age differences existed for several diagnoses.

(Table 4) shows that the RFE “low back symptoms/complaints without radiation” quite often led to the same symptom diagnosis. Also, the rather skewed age distribution of low back complaints shows: most cells were insufficiently filled, while age differences for the most common diagnoses appeared to be relatively small.

TABLE 1
FINAL DIAGNOSES FOR EPISODES OF CARE STARTING WITH THE REASON FOR ENCOUNTER COUGH (R05) N=11092

TABLE 2
FINAL DIAGNOSES FOR EPISODES OF CARE STARTING WITH THE REASON FOR ENCOUNTER SHORTNESS OF BREATH (R02); N=2505

TABLE 3
FINAL DIAGNOSES FOR EPISODES OF CARE STARTING WITH THE REASON FOR ENCOUNTER GENERAL WEAKNESS/TIREDNESS (A04); N=5915

TABLE 4
FINAL DIAGNOSES FOR EPISODES OF CARE STARTING WITH THE REASON FOR ENCOUNTER LOW BACK SYMPTOMS/COMPLAINTS WITHOUT RADIATION (L03); N=4238

Discussion

Family practice can be characterized by the specific distribution of health problems and disease in its population, as distinct from the distributions in the general population and in specialists’ populations. Increasingly, empiric data indicate how morbidity patterns and the distribution of reasons for visit in family practice differ from those in hospitals. The availability of age-specific prior probabilities of common symptoms and complaints for diagnoses in family practice has great potential. Diagnostic labels often have the disadvantage of a relative uncertainty, caused by a more or less arbitrary attribution of different symptoms and signs (eg, syndrome diagnoses, psychiatric diagnoses). Symptoms and complaints on the other hand have the advantage of relative certainty, because they represent the patient’s ill health irrespective of the diagnostic label they are given. In the daily work of FPs the importance of the absence or presence of a symptom must be considered in light of the distribution of disease in the family practice setting.

Therefore, such data would not only seem to be crucial for the further development of family practice as an academic discipline or for the design of intervention studies but also has direct practical consequences for clinicians. This information can directly support FPs’ medical decision making and improve communication with patients. The process of finding common ground about diagnosis and management could especially profit from a realistic estimate of probabilities, bridging the gap between the patient’s perspective, as reflected in the presenting symptoms, and the clinical perspective of the FP who wants to provide optimal care.²¹

Several important types of distributions are shown in (Table1) through 4: a very common symptom in relation to highly incident diagnoses, a less common symptom leading to less incident diagnoses, and symptoms primarily resulting in a symptom diagnosis with the same label. Also, it is evident that the range of clinical considerations resulting from a presenting symptom can vary from a relatively limited to a very wide morbidity spectrum.

Sex-specific symptoms and complaints (eg, menstrual problems) typically result in rather specific distributions, as is illustrated in the database available on the JFP Web site. The distribution of diagnoses for symptoms that occur in both sexes may be different not only for age groups but also for sex /age groups.