Published 15 June 2009, doi:10.1136/bmj.b1878
Cite this as: BMJ 2009;338:b1878

Practice

Diagnosis in General Practice

Test of time

¹ Department of Primary Health Care, University of Oxford, Oxford OX3 7LF

The test of time is not appropriate when "red flag" symptoms warrant immediate referral, but it can be helpful in patients presenting with common problems, such as diarrhoea (doi: 10.1136/bmj.b1877), that have a known clinical course

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

Patients often present to general practitioners with symptoms or signs that are ill defined and evolving, making it difficult to slot them neatly into a diagnostic category. In a cohort study of 500 patients presenting with common symptoms, 70% had improved at two weeks’ follow-up, and 60% of the remainder had improved at three months.¹ Making a precise diagnosis of all presenting problems is arguably not only unnecessary but also potentially damaging both to the patient and to the overall healthcare budget.²

General practice presents a good opportunity for using the test of time for diagnosis since arranging reassessment is relatively easy. Gray says that the general practice consultation should be seen as a total of 47 minutes spread over the course of a year, rather than a discrete 10 minute entity, allowing repeated evaluation in situations of diagnostic uncertainty.³

Diagnosis by test of time involves a careful initial assessment . . . [Full text of this article]

Cough
Sore throat
Conjunctivitis
Diarrhoea
Back pain
Knee complaint

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Iterative diagnosis

Geoff Norman, Kevin Barraclough, Lisa Dolovich, and David Price
BMJ 2009 339: b3490. [Extract] [Full Text]

The rhythm method

Jane Smith
BMJ 2009 339: b2668. [Extract] [Full Text]

Acute diarrhoea in adults

Roger Jones and Greg Rubin
BMJ 2009 338: b1877. [Extract] [Full Text]

Diagnosis using "test of treatment"

Paul Glasziou, Peter Rose, Carl Heneghan, and John Balla
BMJ 2009 338: b1312. [Extract] [Full Text]

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Nicholas Henschke, Christopher G Maher, Kathryn M Refshauge, Robert D Herbert, Robert G Cumming, Jane Bleasel, John York, Anurina Das, and James H McAuley
BMJ 2008 337: a171. [Abstract] [Full Text] [PDF]

Whooping cough in school age children with persistent cough: prospective cohort study in primary care

Anthony Harnden, Cameron Grant, Timothy Harrison, Rafael Perera, Angela B Brueggemann, Richard Mayon-White, and David Mant
BMJ 2006 333: 174-177. [Abstract] [Full Text] [PDF]

ABC of psychological medicine: Functional somatic symptoms and syndromes

Richard Mayou and Andrew Farmer
BMJ 2002 325: 265-268. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Norman, G., Barraclough, K., Dolovich, L., Price, D. (2009). Iterative diagnosis. BMJ 339: b3490-b3490 [Full text]  
• Jones, R., Rubin, G. (2009). Acute diarrhoea in adults. BMJ 338: b1877-b1877 [Full text]  

Rapid Responses:

Read all Rapid Responses

What is time?

Hugh Mann
bmj.com, 16 Jun 2009 [Full text]

Online poll

Find out more >>