Research article

Clinicians' management strategies for patients with dyspepsia: a qualitative approach

Kerstin Knutsson¹ , Bodil Ohlsson² and Margareta Troein³

¹Faculty of Odontology, Centre for Oral Health Sciences, Malmö University, Malmö, Sweden

²Department of Clinical Sciences, Gastroenterology and Hepatology Division, Malmö University Hospital, Lund University, Lund, Sweden

³Department of Community Medicine, Malmö University Hospital, Lund University, Lund, Sweden

author email corresponding author email

BMC Gastroenterology 2005, 5:15doi:10.1186/1471-230X-5-15

Published:	15 May 2005

Abstract

Background

Symptoms from the upper gastrointestinal tract are frequently encountered in clinical practice and may be of either organic or functional origin. For some of these conditions, according to the literature, certain management strategies can be recommended. For other conditions, the evidence is more ambiguous. The hypothesis that guided our study design was twofold: Management strategies and treatments suggested by different clinicians vary considerably, even when optimal treatment is clear-cut, as documented by evidence in the literature. Clinicians believe that the management strategies of their colleagues are similar to their own.

Methods

Simulated case histories of four patients with symptoms from the upper gastrointestinal tract were presented to 27 Swedish clinicians who were specialists in medical gastroenterology, surgery, and general practice and worked at three hospitals in the southern part of Sweden. The patients' histories contained information on the patient's sex and age and the localisation of the symptoms, but descriptions of subjective symptoms and findings from examinations differed from history to history. Interviews containing open-ended questions were conducted.

Results

For the same patient, the management strategies and treatments suggested by the clinicians varied widely, as did the strategies suggested by clinicians in the same speciality. Variation was more pronounced if the case history noted symptoms but no organic findings than if the case history noted unambiguous findings and symptoms. However, even in cases with a consensus in the scientific literature on treatment, the variations in clinicians' opinion on management were pronounced.

Conclusion

Despite these variations, the clinicians believed that the decisions made by their colleagues would be similar to their own. The overall results of this study indicate that we as researchers must make scientific evidence comprehensible and communicate evidence so that clinicians are able to interpret and implement it in practice. Of particular significance is that scientific evidence leads to an evidence-based care which is effective clinical practice and to the promotion of health from the perspective of the patient, together with cost-effectiveness as a priority.