GPs should go with their gut feeling when they suspect serious disease, say researchersBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3568 (Published 29 May 2014) Cite this as: BMJ 2014;348:g3568
A general practitioner’s suspicion of serious disease should be enough to ensure rapid investigation even in the absence of conventional signs and symptoms, Danish researchers have said.1 A prospective population based cohort study involving over 400 GPs and 16 000 patient contacts found that a GP’s suspicion at the end of a consultation was strongly predictive of cancer or serious disease.
A total of 404 of the 845 invited GPs from a mix of urban, semi-urban, and rural practices in central Denmark participated in the study, published in the British Journal of General Practice. The GPs registered consultations for one working day, including information on their suspicion of the presence of cancer or other serious disease. The patients were then followed up through national registers.
Of the 4518 patients who had a face to face consultation and were aged 18 or over, GPs suspected cancer or serious disease in 257 (5.7%). Higher age, as well as presentation of symptoms from the digestive system, from blood or blood forming organs, or from female genitals, were associated with suspicion of serious disease. The prevalence of suspicion was highest among men, older patients, patients with chronic diseases, and retired people.
The risk of a diagnosis of cancer or another serious disease was higher within the first two months after consultation among patients in whom GPs had suspected this, compared with those with no suspicion (adjusted hazard ratio 2.98 (95% confidence interval 1.93 to 4.62)). Of the 42 patients in whom the GPs’ suspicion was confirmed, 22 (52.4 (37.7 to 66.6)) had symptoms clearly related to the subsequent diagnoses, such as intermenstrual bleeding and endometrial cancer. The study found that the positive predictive value of a GP’s suspicion was 9.8% for cancer or other serious disease within two months of the initial consultation and 16.4% within six months.
The authors said that the current fast track systems in Denmark and the United Kingdom, which require patients to present with specific “alarm” symptoms to qualify for immediate referral, were not good enough, as many patients in general practice presented with vague or unspecific symptoms. They called for GPs to have access to relevant and speedy diagnostic investigations, such as endoscopy and imaging, if they suspected serious disease.
Cite this as: BMJ 2014;348:g3568