What conditions are often missed

This question refers to the common 'pitfalls' so often encountered in general practice. This area is definitely related to the experience factor and includes rather simple non-life-threatening problems that can be so easily overlooked unless doctors are prepared to include them in their diagnostic framework. Classic examples include smoking or dental caries as a cause of abdominal pain; allergies to a whole variety of unsuspected everyday contacts; foreign bodies; occupational or environmental hazards as a cause of headache, respiratory discomfort or malaise; and faecal impaction as a cause of diarrhoea. We have all experienced the 'red face syndrome' from a urinary tract infection whether it is the cause of fever in a child, lumbar pain in a pregnant woman or malaise in an older person. The dermatomal pain pattern caused by herpes zoster prior to the eruption of the rash (or if only a few sparse vesicles erupt) is a real trap.

Menopausal symptoms can also be overlooked as we focus on a particular symptom. Some important pitfalls are given in Table 15.3 .

Table 15.3 Classic pitfalls

Abscess (hidden) Allergies Candida infection Chronic fatigue syndrome Coeliac disease

Domestic abuse including child abuse

Drugs (see Table 15.4)

Herpes zoster

Faecal impaction

Foreign bodies

Giardiasis

Haemochromatosis

Lead poisoning Malnutrition (unsuspected) Menopause syndrome Migraine (atypical variants) Paget's disease Pregnancy (early) Seizure disorders Tourette's syndrome Urinary infection

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