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Diagnostic tests for non-specific symptoms ‘do not reassure patients’

Referring patients with non-specific symptoms for diagnostic tests does not reassure them about their condition, though it may reduce subsequent GP visits, concludes a new analysis.

UK researchers showed no significant effect on the level of concern in patients who were referred for diagnostic tests even though they were unlikely to be caused by serious illness, compared with those who received usual care.

But diagnostic referrals in this group of patients did reduce subsequent visits to primary care, compared with patients who underwent usual treatment, by almost a quarter.

Their meta-analysis looked at 14 randomised controlled trials that contained adults with symptoms indicating a low probability of serious disease, based on their clinical features, such as headache, back pain or chest pain.

Guidelines commonly recommend these non-specific symptoms only warrant referrals for investigations if they are accompanied by other clinical signs suggesting disease e.g. current NICE guidelines on headache – one of the conditions featured in the review – recommend consideration of investigation only if patients present with a number of features, such as a change in personality or new neurological deficit.

This analysis - published in JAMA Internal Medicine last month - looked at the effect of referring patients with non-specific signs of disease for imaging, radiography, electrocardiography and other investigations, and compared this with a control group that was given usual care, which included initial non-testing.

Patients in the diagnostic testing group had a 10% decrease in the level of illness concern short-term, compared with usual care, but this difference was not statistically significant. But there was a significant 23% reduction in the rate of subsequent visits to primary care overall in the diagnostics groups, compared with usual care.

Study lead Dr Chris Burton, GP and clinical lecturer at the University of Aberdeen, said that the findings suggest GPs overestimate the effect of a referral on patient attitudes to their health.

He said: ‘Doctors and health care organisations should be aware of the limitations of the transient reassurance provided by negative diagnostic test results and should limit tests to those that influence clinical management.’

But Dr Jane Lothian, a GP in Northumberland and secretary of Northumberland LMC, said it can be tricky as many patients request scans or investigations they do not need.

She said: ‘It is often very difficult to explain to patients that for every 100 scans you do, five will show an abnormality that may not have anything to do with their presenting condition. Then you end up heading down blind alleys with investigations as a result.

‘In my population I find these tests can reassure patients, but this might not be the case for the rest of the country.’

Dr David Kernick, a headache GPSI in Exeter and RCGP headache champion, says this study alerts GPs to the importance of being sure why they want to test.

He said: ‘Patient anxiety is rarely a valid reason and the exposure of incidental abnormalities can often lead to significant problems. 10% of brain scans ordered by GPs show incidental abnormalities.’



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