The future of diagnosis in general practice

‘One finger in the throat, and one in the rectum, makes a good diagnostician’.¹

Things have moved on a bit since Sir William Osler’s times, though the importance of diagnosis in primary care remains. Indeed, despite the myriad investigations now available in healthcare, Osler’s emphasis on examination is still pertinent. Equally important, arguably more so, is good history taking. All these communication skills we’ve learnt and all the experience we gain from face-to-face contact makes us better diagnosticians. Yes, you know this, but I make no apology for repeating it. In essence, much of diagnosis in primary care happens without any tests at all. This includes diagnosis of the absence of disease, a key and underappreciated skill. However, three separate changes in primary care investigation are current: increasing use of existing investigations; new forms of testing; and new organisation of testing pathways, both in the UK and elsewhere.