Abstract
BackgroundAssessment of chest pain in general practice is challenging. General practitioners (GPs) often feel uncertainty when dealing with chest pain. The role of new diagnostic tools is yet unclear.Therefore, we aimed to learn: (1) whether or not GPs experience a change in incidence and presentation of chest pain, (2) how GPs deal with uncertainty, and (3) which thoughts, demands and doubts concerning new diagnostic tools occur.MethodsSemi-structured, face to face interview based study, aiming at six main subjects: experienced changes in prevalence of chest pain, the management of chest pain patients, dealing with uncertainty, the GPs’ approach in referring chest pain patients, GPs’ attitude towards ‘unnecessary’ referrals, and the GPs’ suggestions for improving the management of chest pain patients.Results145 GPs in Belgium and the Netherlands were invited to participate, 27 (15 Flemish and 12 Dutch) GPs were interviewed. Data saturation was reached. The number of patients having an acute coronary syndrome among chest pain patients is decreasing, whereas the presentation of atypical complaints increases, together leading to more uncertainty. GPs rely on their own judgment above all, and desire new diagnostic tools only when these tools are of proven added value.ConclusionThe incidence of chest pain in general practice is not decreasing according to the GPs. However, the presentation of chest pain is changing. GPs feel relatively comfortable with referring a considerable number of chest pain patients without ACS, as over-referral is safe. Uncertainty is regarded as a substantial element of their profession. New diagnostic tools are awaited with cautiousness.
Highlights
Assessment of chest pain in general practice is challenging
The challenge of referring patients with chest pain Most guidelines clearly state that general practitioners (GPs) should refer every patient suspected of an acute coronary syndrome (ACS) to secondary care facilities as soon as possible, or General practitioner (GP) should even be bypassed to prevent loss of time and, myocardial cell necrosis [9]
In our study, we aimed to explore the following topics: Uncertainty when dealing with chest pain Notwithstanding this strategy to work with low thresholds for referral to maintain the number of missed cases of ACS low, uncertainty among GPs has been a part of dealing with chest pain in general practice for decades [16,17,18]
Summary
Assessment of chest pain in general practice is challenging. General practitioners (GPs) often feel uncertainty when dealing with chest pain. The challenge of (not) referring patients with chest pain Most guidelines clearly state that general practitioners (GPs) should refer every patient suspected of an ACS to secondary care facilities as soon as possible, or GPs should even be bypassed to prevent loss of time and, myocardial cell necrosis [9]. For every chest pain patient with a life threatening disease as ACS, a GP encounters 11 patients with chest pain of a non severe cause [1]. Clinical judgement and triage by GPs remains inevitable to prevent unnecessary referrals and to keep the burden on secondary care facilities acceptable [3, 10].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
