title: Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics.
abstract: OBJECTIVE
  The aim was to study symptoms managed as the main problem by the general practitioner (GP) and to describe the frequencies and characteristics of presented symptoms when no specific diagnosis could be made.
  
  
  METHODS
  Cross- sectional study.
  
  
  METHODS
  General practices in the Central Denmark Region.
  
  
  METHODS
  In total, 397 GPs included patients with face-to-face contacts during one randomly assigned day in 2008-2009; 7008 patients were included and 5232 presented with a health problem.
  
  
  METHODS
  GPs answered a questionnaire after each patient contact. Symptoms and specific diagnoses were subsequently classified using the International Classification of Primary Care (ICPC). Symptom frequency, comorbidity, consultation length, and GP-assessed final outcome and burden of consultations were analysed.
  
  
  RESULTS
  The GPs could not establish a specific diagnosis in 36% of patients with health problems. GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients. Musculoskeletal (lower limb and back) and respiratory (cough) symptoms were most frequent. More GPs had demanding consultations when no specific diagnosis could be made. Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made.
  
  
  CONCLUSIONS
  Interpretation and management of symptoms is a key task in primary care. As symptoms are highly frequent in general practice, symptoms without a specific diagnosis constitute a challenge to GPs. Nevertheless, symptoms have been given little priority in research. More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.
authors.affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University , Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Rosendal
authors.forename: Anders Helles
authors.initials: AH
authors.lastname: Carlsen
authors.forename: Mette Trøllund
authors.initials: MT
authors.lastname: Rask
authors.forename: Grete
authors.initials: G
authors.lastname: Moth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003371:Cough / Q000175:diagnosis / Q000209:etiology; D003430:Cross-Sectional Studies; D003718:Denmark; D005260:Female; D058006:General Practice; D058005:General Practitioners; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000209:etiology; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D055815:Young Adult
keywords: Cross-sectional; Denmark; diagnosis; general practice; medically unexplained symptoms (non-MESH); primary health care; signs and symptoms