Background: Patient involvement in treatment decisions is widely accepted. Making a diagnosis, however, is still seen as a technical task mainly driven by physicians. Patients in this respect are perceived as passive providers of data. But, recent patient-centred concepts highlight the value of an active patient involvement in diagnosis.
Objective: We aim to reach a deeper understanding of how patients themselves contribute to the diagnostic process.
Methods: This is an observational study of patient consultations with their General Practitioner (GP) in 12 German practices. We performed a mixed-method qualitative and quantitative analysis of 134 primary care consultations.
Results: At the beginning of most consultations lies a phase where patients were invited to freely unfold their reason for encounter: This was named "inductive foraging" (IF). While patients actively present their complaints, GPs mainly listen and follow the presentation. This episode was found with every GP participating in this study. Ninety-one percent of consultations with diagnostic episodes were opened by IF. IF had a major contribution to the number of cues (diagnostic information) yielded in the diagnostic process. We illustrate a variety of tactics GPs make use of to invite, support, and terminate their patients in IF.
Conclusion: IF was found to be a highly relevant strategy in the diagnostic process. Patient involvement through IF offered a major contribution of diagnostic cues. We hypothesize that a patient-centred approach improves diagnosis.
Keywords: clinical decision-making; diagnosis; medical history taking; physician–patient relations; primary health care; qualitative research.
Making a diagnosis is a central part in medicine. Before advising treatments, physicians need to understand patients’ complaints and ideally the reason for their symptoms. Generating an accurate diagnosis is often attributed to clinicians asking many specific questions and performing an array of tests. The patients’ task in turn is passively answering “yes” or “no,” or donating blood. In this study, we shed a different light on the phenomenon of diagnosis. We observed and recorded 295 primary care consultations. After each consultation, GPs were asked to reflect on their diagnostic thinking during the encounter. At the beginning of consultations, we witnessed a phase where patients were invited to freely report their complains and unfold their reason for encounter. Here, physicians mainly listened to their patients and motivated for further elaboration. We termed this phase “inductive foraging.” GPs received the majority of diagnostic information (cues) during this phase. We therefore belief that an active patient involvement may improve diagnosis.
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