Specificity of early-career general practitioners’ problem formulations in patients presenting with dizziness: a cross-sectional analysis

ObjectivesDizziness is a common and challenging clinical presentation in general practice. Failure to determine specific aetiologies can lead to significant morbidity and mortality. We aimed to establish frequency and associations of general practitioner (GP) trainees’ (registrars’) specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.DesignA cross-sectional analysis of Registrar Clinical Encounters in Training (ReCEnT) cohort study data between 2010 and 2018. ReCEnT is an ongoing, prospective cohort study of registrars in general practice training in Australia. Data collection occurs once every 6 months midtraining term (for three terms) and entails recording details of 60 consecutive clinical consultations on hardcopy case report forms. The outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem formulation. Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.SettingAustralian general practice training programme. The training is regionalised and delivered by regional training providers (RTPs) (2010–2015) and regional training organisations (RTOs) (2016–2018) across Australia (from five states and one territory).ParticipantsAll general practice registrars enrolled with participating RTPs or RTOs undertaking GP training terms.Results2333 registrars (96% response rate) recorded 1734 new problems related to dizziness or vertigo. Of these, 546 (31.5%) involved a specific vertigo diagnosis and 1188 (68.5%) a non-specific symptom diagnosis. Variables associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location (OR 0.94 for each decile of disadvantage, 95% CIs 0.90 to 0.98) and longer consultation duration (OR 1.02, 95% CIs 1.00 to 1.04). A specific vertigo diagnosis was associated with performing a procedure (OR 0.52, 95% CIs 0.27 to 1.00), with some evidence for seeking information from a supervisor being associated with a non-specific symptom diagnosis (OR 1.39, 95% CIs 0.92 to 2.09; p=0.12).ConclusionsAustralian GP registrars see dizzy patients as frequently as established GPs. The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in vertigo/dizziness presentations. Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’ diagnostic processes is indicated.

Medical professionalism: Navigating modern challenges

Medical professionalism is an evolving entity, requiring continual development according to shifting societal priorities. The public trust that underpins the medical profession is imperative for maintaining effective partnerships with patients, their families and the wider community. This article provides an overview of what constitutes medical professionalism, including the current protocols and assessments for general practice training. The aim is to improve understanding of the current issues surrounding professionalism in primary care. Fictional case scenarios are used to illustrate modern professional dilemmas and to promote reflection on the complex interacting factors that influence professional practice and clinical decision-making.

The transgender patient in primary care

The number of people who identify as transgender or non-binary in the UK is increasing. The RCGP has identified that many transgender patients’ experience of healthcare is poor, and that general practitioners may lack experience in the assessment, referral and management of patients with gender dysphoria. This article seeks to cover the key topics in the general practice training curriculum relating to the care of transgender and non-binary adults to allow trainees to practice confidently, safely and compassionately within this field.