Published 19 February 2009, doi:10.1136/bmj.b491
Cite this as: BMJ 2009;338:b491

Practice

Easily Missed?

New primary care series: Easily Missed?

¹ Department of Primary Health Care, University of Oxford, Oxford OX3 7LF, ² Hightown Surgery, Banbury OX16 9DB

doi:10.1136/bmj.a3058doi:10.1136/bmj.b380doi:10.1136/bmj.a3066

The series advisers of this new series explain why heightened awareness is needed of conditions that may be commoner than many doctors realise or may be missed at first presentation

The first 150 words of the full text of this article appear below.

Patients consult doctors with the expectation of an accurate diagnosis and advice on treatment. But in primary care, patients often present with undifferentiated symptoms without an immediately apparent diagnosis. For most conditions this doesn’t matter because the symptoms either resolve or become worse in such a way that the patient returns before any harm is done.¹ In consultations, general practitioners work by using the probability that the collection of presenting symptoms reflects a specific diagnosis. A combination of knowledge, clinical experience, and sound judgment ensures that they usually get it right. The adage "common things are common" directly applies to diagnosis in primary care.² In horse racing parlance, it is usually better to bet on a 6-4 chance than a 66-1 outsider. This, however, assumes that the doctor has an accurate idea of the prior odds³ and that no harm will result if a diagnosis thought to be less probable . . . [Full text of this article]

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