Objective: Analyse on the spot the principal determinants of diagnostic process in primary care.
Methods: In a multicenter observational study, 59 experienced GP evaluated the potential threat of
the clinical condition and their diagnostic hypotheses in 672 consecutive patients with chest pain
during the initial consultation, after three months and after one year.
Results: One or two minutes after the recognition of chest pain, the GPs offered an assessment of the
potential danger in 85% of patients. The cases assessed as potentially dangerous led to aggressive
diagnostic strategies. The diagnostic procedure was consistent from one GP to another and started
very quickly during the consultation with proposed diagnostic hypotheses in 70% after one minute.
This initial impression was often modified subsequently so that the final diagnosis was reached in
51% of cases after one to two minutes, in 81% at the end of the consultation and in 97% after one
year. Diagnostic tests or referral to a specialist were required in half of all patients. The difficulty of
diagnosis and the degree of anxiety of the patients and GPs delayed the diagnostic. Irrational factors
such as personality, anxiety or gender of the physician and of the patient influenced the approach.
This one seems linked to an intellectual endeavour appeared very early in the human evolution.
Conclusion: In primary care, the diagnostic process quickly starts with the assessment of risk
associated with the condition and the laying of first diagnostic hypothesis. This intuitive process
is followed by an analytical activity based on clinical and, if necessary, paraclinical data. It is mainly
founded on the clinic.
