Differences in diagnostic approach between family physicians and other specialists in patients with unintentional body weight loss

Background. Unintentional weight toss is a diagnostic dilemma with diverse diagnostic possibilities for physicians. Objectives. Our study focused on the evaluation of differences in diagnosti c approach between family physicians and physicians in other specialties. Methods. Outpatients who visited National Taiwan University Hospital from J anuary 1996 to December 1996 with unintentional weight loss of 5% or more w ithin 6 months were recruited by a computer search. All data were obtained from a structured medical record audit. Results. There was no significant difference in the utilization of common d iagnostic laboratory tests between the two groups. However, other specialis ts ordered more carcinoembryonic antigen tests (P< 0.01) and hepatitis B an tigen tests (P < 0.05), but fewer upper gastrointestinal tract barium studi es (P < 0.05) than family physicians. For patients without a definite final diagnosis, the diagnostic total costs for laboratory tests and imaging stu dies were lower for family physicians than other specialists (P< 0.01). For patients with biomedical disorders, the diagnostic cost was not significan tly different between the two groups. For patients with psychological disor ders, the costs for imaging studies were lower for family physicians than f or other specialists (P < 0.05) but there was no significant difference in the total costs between these two groups. Conclusions. We conclude that the different approaches between the two grou ps are due to different training backgrounds and characteristics of practic e. The patient-centred concepts of family physicians might be more cost-eff ective in dealing with undifferentiated problems.