Unexplained complaints in general practice: prevalence, patients' expectations, and professionals' test-ordering behavior.
OBJECTIVE
To gain insight into general practitioners' (GPs) test-ordering behavior for patients presenting with unexplained complaints. An unexplained complaint's symptoms are not alarming, and there is no plausible medical or psychosocial explanation for it. The Dutch College of General Practitioners (DCGP) recommends a watchful, waiting attitude for test ordering for unexplained complaints.


METHODS
Observational, cross-sectional study of 567 doctor-patient consultations performed by 21 GPs.


RESULTS
On average, 13% of consultations involved complaints considered unexplained by GPs. Unexplained complaints were positively related to test ordering (adjusted odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.1-5.3), despite the DCGP's recommendation. Patients' expectations about testing influenced test ordering even more (adjusted OR = 4.1, 95% CI 2.2-7.6).


CONCLUSIONS
Unexplained complaints happen daily in general practice. Besides the DCGP's recommendation, factors such as GPs' desire to understand complaints and patients' expectations seem to have impacts. Guideline development and quality improvement projects should respect, next to Bayesian rules, GP- and patient-related determinants of test ordering.
van der Weijden
Trudy
T
Centre of Quality of Care Research, Institute for Extramural and Transmural Research, Department of General Practice, Maastricht University, The Netherlands. trudy.vanderweijden@hag.unimass.nl
van Velsen
Monique
M
Dinant
Geert-Jan
GJ
van Hasselt
Cathelijne M
CM
Grol
Richard
R
D000328:Adult; D003142:Communication; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D015995:Prevalence