title: Diagnostic protocols-A consultation tool still to be discovered.
abstract: Experienced primary care physicians handle most illnesses to everyone's satisfaction despite limited resources of time and means. However, cases can be multifaceted in that harmless-presenting symptoms may also be warning signals or an indicator of a health disorder that too infrequently presents in family practice to be diagnosed correctly. On the basis of these observations, RN Braun developed 82 diagnostic protocols for a structured recording of various complaints.
  
  
  
  All consultations during the years 2001 to 2014, in which 1 author (WF) had used diagnostic protocols in her single-handed practice, were analyzed retrospectively regarding reasons for encounter, diagnostic classification, and long-term outcome.
  
  
  
  During the period, a diagnostic protocol was used 1686 times. It was applied at a rate of approximately 5% of 2500 new complaints annually, most often (1366 times) for febrile conditions. In 320 consultations for other complaints, 43 different diagnostic protocols were applied. Among them, the "tabula diagnostica" for various undifferentiated symptoms was used most frequently (n = 54), followed by diagnostic protocols for headache (n = 45), dizziness (n = 36), precordial pain (n = 20), nonspecific abdominal pain (n = 15), low back pain (n = 14), hypertension (n = 12), diarrhea > 1 week (n = 12), epigastralgia (n = 11), depression (n = 10), polyarthralgia (n = 8), cough, and lower abdominal pain (each n = 7). A final diagnosis was established in less than 20% of cases.
  
  
  
  This observational study from routine practice gives an insight how diagnostic protocols helped to manage complex patient presentations. A broader use of diagnostic protocols could investigate the potential of this consultation tool to handle the complexity of primary health care. The use of a standardized diagnostic approach could stimulate research, in particular on managing common complaints/undifferentiated illness and their inherent diagnostic uncertainty.
authors.affiliation: Straning, Austria.|Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria.
authors.forename: Waltraud
authors.initials: W
authors.lastname: Fink
authors.affiliation: Angern, Austria.|Department of General Practice, Center for Public Health, Medical University Vienna, Austria.|Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria.
authors.forename: Gustav
authors.initials: G
authors.lastname: Kamenski
authors.affiliation: Schwarmstedt, Germany.|Academic Teaching Practice Hannover Medical School (MHH), Hannover, Germany.|Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Konitzer
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D002985:Clinical Protocols / Q000145:classification / Q000592:standards; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000379:methods; D008499:Medical Records; D008875:Middle Aged; D010346:Patient Care Management / Q000379:methods / Q000592:standards; D011320:Primary Health Care / Q000379:methods*; D058996:Quality Improvement; D012017:Referral and Consultation; D063189:Symptom Assessment / Q000379:methods; D013597:Systems Analysis
keywords: ambulatory care; complex adaptive systems; diagnostic; guidelines; medical history taking; medical records; signs and symptoms