A GP’s suspicion of serious disease is more strongly predictive than many of the symptoms and signs conventionally used in schemes such as the two-week rule for urgent suspected cancer referrals, research has concluded.
A study conducted in Denmark, involving over 400 GPs and 16,000 patient contacts, concluded that the two-week wait system used in the UK and Denmark may actually prevent early diagnosis because they are based on symptom check lists, and do not include GPs’ ‘gut feelings’ about serious problems.
The report, published in the British Journal of General Practice, has recommended that referral pathways are reformed so that patients suspected by their GP to suffer from serious condition get rapid, direct access to investigations such as imaging and endoscopy.
The research group, led by Professor Peter Vedsted, demonstrated a positive predictive value for diagnosis of cancer or serious disease of almost 10% in the two months following consultation.
The report concluded: ‘The present study confirms that action should be taken when the GP suspects serious disease; PPVs are relatively high, and the healthcare system should support this investigation by providing access to, for example, imaging and endoscopies. The UK and Denmark have organised cancer investigation as a fast-track system (for example, two-week wait referrals) that requires patients to present with specific alarm symptoms to qualify for immediate referral.’
‘However, as many patients in general practice present with vague or unspecific symptoms, GP access to relevant and speedy diagnostic investigations is crucial. Organisation of the primary diagnostic pathways and how to support GPs should be a main focus in future studies in this area.’