GPs' reasons for referral of patients with chest pain: a qualitative study.
BACKGROUND
Prompt diagnosis of an acute coronary syndrome is very important and urgent referral to a hospital is imperative because fast treatment can be life-saving and increase the patient's life expectancy and quality of life. The aim of our study was to identify GPs' reasons for referring or not referring patients presenting with chest pain.


METHODS
In a semi-structured interview, 21 GPs were asked to describe why they do or do not refer a patient presenting with chest pain. Interviews were taped, transcribed and qualitatively analysed.


RESULTS
Histories of 21 patients were studied. Six were not referred, seven were referred to a cardiologist and eight to the emergency department. GPs' reasons for referral were background knowledge about the patient, patient's age and cost-benefit estimation, the perception of a negative attitude from the medical rescue team, recent patient contact with a cardiologist without detection of a coronary disease and the actual presentation of signs and symptoms, gut feeling, clinical examination and ECG results.


CONCLUSIONS
This study suggests that GPs believe they do not exclusively use the 'classical' signs and symptoms in their decision-making process for patients presenting with chest pain. Background knowledge about the patient, GPs' personal ideas and gut feeling are also important.
Bruyninckx
Rudi
R
Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. Rudi.Bruyninckx@skynet.be
Van den Bruel
Ann
A
Hannes
Karin
K
Buntinx
Frank
F
Aertgeerts
Bert
B
D054058:Acute Coronary Syndrome / Q000175:diagnosis; D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires