The extraordinary diagnostic sensitivity of family physicians

Primary care is the core function in health systems that provide access to health care for all health problems in all patients in all stages of their illness and disease (1). As the first point of contact, an important function is to come to an understanding of the health problem, for which the patient is consulting. In their early stage, diseases may still have minimal and trivial signs and symptoms, even in case of health problems with a major impact on the patient’s health status, and coping with this clinical uncertainty is a major factor of the effectiveness of primary care with family physicians in health systems. But at the same time, there is little evidence of how family physicians operate under these conditions of what determines their competence. Limited evidence of the reliability and predictive value of diagnostic tests in the primary care setting (2) and their ability to rule-in or rule-out under conditions of clinical uncertainty are part of this problem. But even more important is the understanding of family physicians’ diagnostic acuity and clinical reasoning under these conditions of clinical uncertainty: their valuing of (early) signs and symptoms and their oriented, restricted use of additional testing.