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J Fam Pract. 1998 Feb;46(2):153-8.

The patient's differential diagnosis. Unpredictable concerns in visits for acute cough.

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Department of Family Practice and Community Health, University of Minnesota, Minneapolis, USA.



Agreement between physician and patient on the nature of the patient's illness problem is an important goal in primary care consultations. Unfortunately, both patient and doctor are often uncertain about the cause of the problem. The patient's satisfaction with a visit may be correlated with his or her agreement with the physician's differential diagnosis.


Patients' diagnostic concerns elicited by interview just prior to and during 17 visits to family physicians for cough were compared with the doctors' differential diagnoses expressed during and after the visits using qualitative methods.


Patients expressed a mean of 6.5 possibilities, of which a mean of 2.8 were also among the doctors' differential diagnoses. While many concerns were related to widely recognized popular ideas about disease, some patients had idiosyncratic, unpredictable diagnostic concerns about serious illness based on experiences in their families. Concerns were often expressed very indirectly during the visits.


The physician's exploration of patients' uncertainty about the nature of their illnesses may help to elicit unexpected concerns that might otherwise prevent agreement on the nature of the problems.

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