Management of dyspepsia in primary care (V 4.0)

It is commonly assumed that a clinical encounter with a patient presenting with a complaint begins with a diagnosis decision (what is wrong) followed by a treatment decision (what to do) and sometimes a longer term follow-up plan primary care physicians often say that their starting focus is not diagnosis butmanagement of common problems. In the case of dyspepsia and other complaints that can be associated with cancer a GP will typically first elicit any patient complaints or history that suggest even a modest likelihood of disease and if that is present refer the patient urgently to an appropriate oncologist or specialist team. Here the UK GP makes no attempt to diagnose or treat the patient but acts in his/her traditional role as a “gatekeeper” to specialist services. If there are not grounds for suspicion of a life-threatening or complex condition the GP will go on to take a more detailed history with a view to managing the patient in the practice. Sometimes the clinician will formulate a diagnostic hypothesis and this may lead to a request for a test or investigation, or directly to deciding on a treatment and prescribing appropriately.