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Background Incidental findings (IFs) are discovered by chance and are unrelated to the patients’ clinical features. They can be life-saving but also harmful leading to unwarranted investigations and treatments. They can create anxiety for patients, and for clinicians who may have increased work-loads. Furthermore, additional appointments and investigations have economic costs.
Aim We aimed to assess the impacts of IFs within primary care.
Method Written consent was obtained for this qualitative, retrospective study which consisted of 20 semi-structured UK GP interviews using Grounded Theory. Phenomena were categorised using constant comparative analysis to achieve thematic saturation. Data on the number and duration of contacts and additional investigations needed were also recorded.
Results IFs generated anxiety for GPs, particularly when communicating them to patients. IFs increased workload, resulting in more consultations, referrals and investigations. Neuroimaging was noted to be particularly problematic. GPs relied heavily on the written report of radiologists, who acted as patient advocates and gate-keepers of economic costs. GPs stated that direct communication with radiologists avoids unnecessary investigations and led to more satisfactory management plans. GPs wanted algorithms to manage common IFs. Access to imaging within primary care has increased and GPs acknowledged a need for greater understanding of imaging indications and their limitations.
Conclusion It is timely to analyse the impacts of IFs on primary care and to act to improve GP-radiologist communication; to improve education within primary care; and to encourage the creation of consensual and ethical guidelines on the management of common IFs.
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British Journal of General Practice
