'It's like a Gordian knot' - the management of patients with persistent postconcussion symptoms in general practice: a qualitative study.

Abstract

General practitioners (GPs) function as the primary coordinative healthcare professionals for patients with persistent post-concussion symptoms (PPCS) who are at risk of protracted disability. The study aimed at exploring GPs' perspectives on managing patients with PPCS and at identifying the barriers they perceive in treating this patient group. Semi-structured in-depth interviews with 12 GPs from different geographical regions. All GPs had experience with management of patients with PPCS in general practice. The study identified three main themes representing the perceived challenges: (i) managing patients with PPCS, (ii) coordination with other actors, and 3) GPs' clinical gaze on patients with PPCS. GPs perceived management of this patient group as challenging due to the limited guidelines, diagnostic consensus, and resources. They struggled with insufficient referral options in the public healthcare system both regarding secondary sector and municipalities. The absence of biomedical evidence lead some to be skeptical about the condition, especially in female patients. However, ultimately they strived to embrace the biomedically unknown and approach their patients with trust. GPs face significant challenges in managing PPCS due to insufficient translation of guidelines, diagnostic uncertainties, and scarce referral options. Despite skepticism fueled by the lack of biomedical evidence, they endeavor to approach each patient with an open mind. The results underscore the need for improved resources and referral pathways to support GPs in treating patients with PPCS effectively.