RT Journal Article
SR Electronic
T1 Diagnosing headache in primary care: a qualitative study of GPs’ approaches
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e532
OP e537
DO 10.3399/bjgp14X681325
VO 64
IS 626
A1 Stefan Bösner
A1 Simone Hartel
A1 Judith Diederich
A1 Erika Baum
YR 2014
UL http://bjgp.org/content/64/626/e532.abstract
AB Background Headache is one of the most common symptoms in primary care. Most headaches are due to primary headaches and many headache sufferers do not receive a specific diagnosis. There is still a gap in research on how GPs diagnose and treat patients with headache.Aim To identify GPs’ diagnostic approaches in patients presenting with headache.Design and setting Qualitative study with 15 GPs in urban and rural practices.Method Interviews (20–40 minutes) were conducted using a semi-structured interview guideline. GPs described their individual diagnostic strategies by means of patients presenting with headache that they had prospectively identified during the previous 4 weeks. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters.Results Regarding GPs’ general diagnostic approach to patients with headache, four broad themes emerged during the interviews: ‘knowing the patient and their background’, ‘first impression during consultation’, ‘intuition and personal experience’ and ‘application of the test of time’. Four further themes were identified regarding the management of diagnostic uncertainty: ‘identification of red flags’, ‘use of the familiarity heuristic’, ‘therapeutic trial’, and ‘triggers for patient referral’.Conclusion GPs apply different strategies in the early diagnostic phase when managing patients with headache. Identification of potential adverse outcomes accompanied by other strategies for handling uncertainty seem to be more important than an exact diagnosis. Established guidelines do not play a role in the diagnostic workup.