"I can't find anything wrong: it must be a pulmonary embolism": Diagnosing suspected pulmonary embolism in primary care, a qualitative study

Before using any prediction rule oriented towards pulmonary embolism (PE), family physicians (FPs) should have some suspicion of this diagnosis. The diagnostic reasoning process leading to the suspicion of PE is not well described in primary care. to explore the diagnostic reasoning of FPs when pulm...

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Bibliographic Details
Published in:PloS one 2014-05, Vol.9 (5), p.e98112-e98112
Main Authors: Barais, Marie, Morio, Nathalie, Cuzon Breton, Amélie, Barraine, Pierre, Calvez, Amélie, Stolper, Erik, Van Royen, Paul, Liétard, Claire
Format: Article
Language:English
Subjects:
Analysis
Biology and Life Sciences
Diagnostic software
Diagnostic systems
Diagnostic Techniques, Respiratory System - standards
Embolism
Embolisms
Error detection
Family medicine
Family Practice - methods
Family Practice - standards
France
Grounded Theory
Health care
Humans
Interdisciplinary aspects
Interviews
Interviews as Topic
Intuition
Medical diagnosis
Medical personnel
Medicine
Medicine and Health Sciences
Patients
Physicians
Primary care
Primary Health Care - methods
Primary Health Care - standards
Pulmonary arteries
Pulmonary embolism
Pulmonary Embolism - diagnosis
Pulmonary embolisms
Qualitative analysis
Qualitative reasoning
Qualitative research
Reasoning
Research and Analysis Methods
Sampling methods
Studies
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Summary:Before using any prediction rule oriented towards pulmonary embolism (PE), family physicians (FPs) should have some suspicion of this diagnosis. The diagnostic reasoning process leading to the suspicion of PE is not well described in primary care. to explore the diagnostic reasoning of FPs when pulmonary embolism is suspected. Semi-structured qualitative interviews with 28 FPs. The regional hospital supplied data of all their cases of pulmonary embolism from June to November 2011. The patient's FP was identified where he/she had been the physician who had sent the patient to the emergency unit. The first consecutive 14 FPs who agreed to participate made up the first group. A second group was chosen using a purposeful sampling method. The topic guide focused on the circumstances leading to the suspicion of PE. A thematic analysis was performed, by three researchers, using a grounded theory coding paradigm. In the FPs' experience, the suspicion of pulmonary embolism arose out of four considerations: the absence of indicative clinical signs for diagnoses other than PE, a sudden change in the condition of the patient, a gut feeling that something was seriously wrong and an earlier failure to diagnose PE. The FPs interviewed did not use rules in their diagnostic process. This study illustrated the diagnostic role of gut feelings in the specific context of suspected pulmonary embolism in primary care. The FPs used the sense of alarm as a tool to prevent the diagnostic error of missing a PE. The diagnostic accuracy of gut feelings has yet to be evaluated.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0098112