Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways

Gillian E Doe; Marie T Williams; Stacey Chantrell; Michael C Steiner; Natalie Armstrong; Ann Hutchinson; Rachael A Evans

doi:10.3399/BJGP.2022.0475

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson@gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Accepting age-related chronic symptoms with patient-centered care
Ryuichi Ohta

Published on: 23 June 2023
Delays in diagnosing breathlessness
John Sharvill

Published on: 26 May 2023

Published on: (23 June 2023)
Page navigation anchor for Accepting age-related chronic symptoms with patient-centered care
Accepting age-related chronic symptoms with patient-centered care
Ryuichi Ohta, Family physician, Unnan City Hospital, Japan
I have read, with great respect, the research titled “Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways.”¹ This research clarified the critical insights about the management of breathlessness for both physicians and patients. Breathlessness can be subjective, and the diagnosis can be challenging in chronic conditions. Subjective symptoms can be modified with patients’ previous experiences and socioeconomic status. This article shows that physicians try to be objective, so the conflict between physicians and patients can appear. The suggested approaches to breathlessness are the basis of family physicians and respect for patient-centered care for chronic breathlessness.

One of the vital things to approach chronic symptoms such as subjective breathlessness is patient-centered care for accepting aging, especially among older patients. Some older people may not accept the aging and persist in inquiring about other etiologies of their symptoms not related to aging even though ruling out critical diseases.² For accepting age-related symptoms, patient-centered care is essential and respect their perceptions about their symptoms. The continual dialogue among older patients and healthcare professionals can mitigate the patients’ difficulty in accepting aging, which enables them to live with their chronic symptoms, such as breathlessness.^3...
Show More

I have read, with great respect, the research titled “Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways.”¹ This research clarified the critical insights about the management of breathlessness for both physicians and patients. Breathlessness can be subjective, and the diagnosis can be challenging in chronic conditions. Subjective symptoms can be modified with patients’ previous experiences and socioeconomic status. This article shows that physicians try to be objective, so the conflict between physicians and patients can appear. The suggested approaches to breathlessness are the basis of family physicians and respect for patient-centered care for chronic breathlessness.

One of the vital things to approach chronic symptoms such as subjective breathlessness is patient-centered care for accepting aging, especially among older patients. Some older people may not accept the aging and persist in inquiring about other etiologies of their symptoms not related to aging even though ruling out critical diseases.² For accepting age-related symptoms, patient-centered care is essential and respect their perceptions about their symptoms. The continual dialogue among older patients and healthcare professionals can mitigate the patients’ difficulty in accepting aging, which enables them to live with their chronic symptoms, such as breathlessness.³

Not depending on organ-specific specialists regarding dealing with chronic symptoms related to aging, family physicians should focus on their practical communication skills with patient-centered approaches involving patients, families, and multiple healthcare professionals.

References
1. Doe GE, Williams MT, Chantrell S, et al. Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways. Br J Gen Pract 2023;73(731):e468-e477. DOI: 10.3399/BJGP.2022.0475.
2. Jaul E, Barron J. Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Public Health 2017;5:335. (In eng). DOI: 10.3389/fpubh.2017.00335.
3. Fleming MO, Haney TT. An imperative: patient-centered care for our aging population. Ochsner J 2013;13(2):190-3. (In eng).

Show Less

Competing Interests: None declared.
Published on: (26 May 2023)
Page navigation anchor for Delays in diagnosing breathlessness
Delays in diagnosing breathlessness
John Sharvill, GP, NHS
I received my paper copy of the BJGP the same day as Dr Copperfield wrote in Pulse that guidelines and best practice get in the way of timely care.

I am aware of the wrong diagnosis is considered common but there are many obstacles that hinder care. Spirometry is a cause of obvious delay. Instead of a relatively quick ‘whilst you are here’ to give some idea of FEV1, FVC and PEF this now has to be done by someone with a gold standard ticket hence a delay. As more and more guidelines 'refer to a specialist nurse/or someone with a special interest in disease x', it is not surprising GPs are getting de skilled and people wait longer. As Dr Copperfield said the test advised for asthma (FeNO) don’t appear to exist in most areas

An example. At a junior parkrun the adult tail walker was surprisingly short of breath when the small children sprinted the last 100 metres. An informal non-medical chat with him revealed that he mentioned to his GP in Feb 2022 about his symptoms and was referred for lung function tests. He is still waiting. In my area many practices stopped spirometry (and ear syringing) during COVID and have not restarted.

Competing Interests: None declared.