Common Presentations
One of the challenges of general practice is taking patient symptoms and trying to make medical sense of them. This is where the skill of history taking lies – asking the right questions to guide you towards a diagnosis. In general practice it is not possible to ask every question of every patient and so the key is to allow the patient to talk as much as possible and ask questions that aim to draw out their story so that you can begin to construct a narrative of their health, whether that is the physical, mental or social aspects.
With that being said, it is helpful to have an idea of some of the possible underlying diagnoses for common presentations in primary care as this can help you to focus your consultation. Listed below are some of the common presenting symptoms in primary care – you might find it helpful to go through each of these symptoms and consider underlying diagnoses from the different systems: cardiac, respiratory, haematological, renal, endocrine, etc.
● e.g. Shortness of breath (SOB), Chest pain, Headache, Tired all the time (TATT)
History Taking Dilemma #1 in Primary Care: “The Patient doesn’t have a presenting complaint!”
Patients can present to their GP with acute problems as in a hospital setting, but equally present for a review of their blood pressure or their medications, or a review of their ongoing chronic condition (including mental health), or a review of a resolving acute episode.
History Taking Dilemma #2 in Primary Care: “The Patient has LOTS of presenting complaints!”
Patients often come to see their GP with a list of issues to discuss and you will see clinicians use various strategies to manage this. In GP3, often patients are brought in specifically to speak to you, so in your clerking you may want to explicitly focus upon one of their conditions (presenting complaint being “diabetes review” for example) and collect information about their other issues as part of your review of symptoms in order to generate a comprehensive problem list for when you present the case to your peers and your GP Tutor.