Serious, what and how

Serious?

What is the cause?

How do I manage it?

The “GP sieve” used in every consultation is a three step process. Following the three steps makes patient care safer and makes the consultation simpler.

Serious?

What are the serious causes of these symptoms. Have you covered each one and excluded them. Have you documented the reassuring findings? If it is serious then you need to consider referring now. It is worse mentioning toyour patient that you have excluded these serious causes. Often they will have worried about them already and it will help put their mind to rest and speed their recovery if you explain why they are unlikely. Also it informs your patient of what to do if warning signs and symptoms do occur.

What is the cause?

This is a more specific question and one which you wil often not have an answer to. It may be best to discuss the range of possible causes with your patient so that they are fully infomed and can come back with more information or if problems arise

How do I manage it?

This is the question you will always have to answer and often needs some practical common sense particularly if the cause is unclear

Continue to exclude the serious, consider the common and think widely about the cause

 

 Case Study

40yr old man presents with chest pain. It may be serious and a heart attack, pulmonary embolism or pneumonia is possible. As it may be serious you will be thinking of admitting to hospital and your management is becoming clear already.

Your history and examination helps you exclude some serious diagnoses but not all. No fever, no blood in the phleghm, no calf pains. The pain is more on twisting and breathing so sounds more muscular but you have to admitt to hospital to exclude serious causes.