Fifteen GPs in the federal states of Hessen, Bavaria and North Rhine Westphalia (Germany) were approached. GPs were recruited via personal contacts and among GPs affiliated with the University department. GPs were contacted in advance, given an explanation of the aim of the study and they gave written permission for inclusion in the study. A flexible interview guide was designed based on recent literature on headache in primary care. It was explained to the GPs that the study was about understanding how they managed patients with headache, and what role intuition, clinical experience, and diagnostic uncertainty played in their daily routine with these patients. To elucidate their diagnostic approaches, the participating GPs were asked to collect information on every patient presenting with headache in their practice during the following 4 weeks. After these 4 weeks a second appointment for the interview was arranged. The collected patient data were exclusively used by the GPs to aid recall during the interview (‘stimulated recall’),15 but were not presented to the interviewer.
How this fits in
GPs use a broad range of diagnostic strategies in the workup of patients with headache. GPs found it more important to have effective strategies for handling uncertainty than to make an exact diagnosis.
The semi-structured interview began with a question about the overall number of patients and the diagnoses collected by the respective GP. Afterwards, GPs were invited to recall the consultation of these patients. A semi-structured interview guideline was used to cover all relevant topics (history taking, examination and further diagnostic investigations, identification of red flags, GPs diagnostic strategies and individual heuristics, and dealing with uncertainty). Participants were asked about central aspects of clinical history and physical examination, the use of scores or any other (also individual) algorithms that helped GPs in the differential diagnosis of their specific cases. Additionally, the authors were interested in determining what GPs thought about the role of intuition and gut feeling. GPs’ reflections on their diagnostic reasoning or individual diagnostic strategies concluded the interview. Interviews were arranged at the GPs’ convenience and lasted between 20–40 minutes each.
