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Patient-centred diagnosis

Nicholas Summerton's book on primary care diagnostics is chock full of statistics, but thought provoking nonetheless, according to Dr Clare Etherington

Nicholas Summerton's book on primary care diagnostics is chock full of statistics, but thought provoking nonetheless, according to Dr Clare Etherington



This book is written by a practising GP with a research interest in primary care diagnostics. The author emphasises the differences in differential diagnosis faced by GPs in the community, as opposed to those faced by secondary care physicians examining a pre-filtered group of patients.

These differences are apparent both in the percentage of patients seen suffering from serious disease, and in the uncertainties faced by GPs when seeing patients presenting at early and undifferentiated stages of illness.

The author has a background in epidemiology so the book is filled with discussions about statistics and how to use them. Although many ordinary GPs may recoil from statistics, the author presents them in clear, understandable terms and uses real examples from general practice to illustrate his point.

In the chapters on patient-centred diagnosis, he puts the focus back on the patient and the findings from history and examination, rather than on technology. There is an interesting discussion of the relative validities (the degree to which a finding actually relates to the truth) of clinical history and examination findings versus diagnostic tests - for example a history of hot flushes is a better discriminator of menopausal status than measurement of FSH.

In the chapters on history taking and examination, he looks at the probability that any particular patient has serious illness, and how to focus on questions and examination that hone these probabilities until a decision about diagnosis and management can be made.

This is a book for GPs who wish to take a step back from daily practice and think about the reasons behind what their actions. Although it is not a statistical textbook, the author expects an understanding of simple stats.

For a GP prepared to make the effort, the statistics provoke thought about why we ask the questions and do the tests we do and how we can use history taking, examination and tests to allow us to deal with the diagnostic uncertainties in primary care.

The basic message is that in this modern world of technological advances, near-patient testing and defensive medicine, if we listen to and look at our patients we can usually find out what is wrong with them.

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