A safe diagnostic strategy

For most diagnoses all that is needed is an ounce of knowledge, an ounce of intelligence, and a pound of thoroughness.

Anon

Lancet 1951

The discipline of general practice is probably the most difficult, complex and challenging of the healing arts. Our field of endeavour is at the very front line of medicine and as practitioners we shoulder the responsibility of the early diagnosis of very serious, perhaps life-threatening, illness in addition to the recognition of anxiety traits in our patients.

The teaching of our craft is also an exciting challenge and presupposes that we have a profound comprehension of our discipline.

Our area is characterised by a wide kaleidoscope of presenting problems, often foreign to the classical textbook presentation and sometimes embellished by a 'shopping list' of seemingly unconnected problems or vague symptoms—the so-called undifferentiated illness syndrome. 1 Common undifferentiated symptoms include tiredness or fatigue, sleeping problems, anxiety and stress, dizziness, headache, indigestion, anorexia and nausea, sexual dysfunction, weight loss, loss of interest, flatulence, abdominal discomfort and chest discomfort. 2 It is important, especially in a busy practice, to adopt a fail-safe strategy to analyse such presenting problems. Such an approach is even more important in a world of increasing medical litigation and specialisation. To help bring order to the jungle of general practice problems the author has developed a simple model to facilitate diagnosis and reduce the margin of error.

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