Common Complaints in Primary Care - An Overview

Primary healthcare aims at providing comprehensive treatment to patients. This article emphasizes the common primary health complaints.

Medically reviewed by

October 25, 2023

October 25, 2023

Introduction

A chief complaint describes the symptoms and problems of an individual in their own words. The patient seeks medical attention for a variety of complaints. Primary healthcare (PHC) consists of a general practitioner, pharmacist, dentist, and nurse. PHC ensures people receive comprehensive care that ranges from prevention to treatment, rehabilitation, and palliative care. Developing countries face many health challenges at the PHC level.

What Are the Common Complaints and Their Management at the Primary Healthcare Level?

Studies show that about 80 percent of the Indian population visits a private practitioner seeking primary healthcare. However, the majority of the health complaints-related data are acquired from hospitals and PHCs. The most common complaints are:

1. General: Fever, pain, weakness, and fatigue are the most common general complaints of a patient.

• Fever: Fever is the body’s natural defense mechanism. It is one of the most common primary health complaints presented to physicians. Various infectious and noninfectious conditions cause fever. Malaria and dengue are the most common infectious causes of fever in India. A common management approach depends on the correct diagnosis and use of antibiotics and antipyretics (medications against fever). Rectal, axillary (under the armpit), and oral thermometers are commonly used methods to check the temperature.
• Pain: Pain is another frequent chief complaint.
• Weakness and Fatigue: Weakness and fatigue are seen more in females as females suffer more from anemia.

2. Respiratory: Cough, sore throat, and runny nose are the most common respiratory complaints. An acute cough is associated with an upper respiratory tract infection, also called common cold. It is caused by a virus, but bacterial infections can superimpose. A chronic cough requires referral to a pulmonologist. Sore throat accompanies cough most of the time. A runny nose is another complaint. It is due to inflammation of the nasal lining (rhinitis). Asthma and COPD (chronic obstructive pulmonary disease) are the other frequent respiratory complaints.

3. Digestive: Under the age of 30, digestive complaints are common after respiratory symptoms. Abdominal pain, diarrhea, nausea, and vomiting are mostly encountered. Abdominal pain may be due to an infection or inflammation. Acute gastritis and gastroenteritis (AGE) are very frequent. The causative organism of AGE can be a virus or bacteria. Severe abdominal pain can be due to an obstruction. Emergency intervention is mandatory.

4. Musculoskeletal: Backache, leg pain, and knee injuries are musculoskeletal problems. Lower backache is the principal cause of disability worldwide. It is a leading cause of early retirement and poverty. Some patients with a specific cause need diagnostic imaging. Acute back pain is preferably managed with nonpharmacologic treatments. Superficial heat and acupuncture are used for initial management.

5. Nutritional: Weight loss, weight gain, and loss of appetite are the nutritional issues mostly reported by patients. Feeding problems among adults are also seen.

• Some conditions cause unexplained weight loss. Cancer, depression, hyperthyroidism, medications, memory loss (dementia), and brain disorders are some examples.
• Weight gain leads to obesity. Obesity involves excessive body fat. It is a medical issue that increases the risk of other illnesses such as high blood pressure, heart diseases, diabetes mellitus, and some cancers.
• Loss of appetite is the decreased wish to eat. Aging is a natural cause of loss of appetite. Bacterial and viral infections, depression and anxiety, and medical diseases are the other causes. Better diet, sleep, self-care, and exercise can be beneficial. A history, physical examination, laboratory tests (complete blood count), various organ function tests, and urine examination can help in the diagnosis.

6. Cardiovascular: Cardiovascular pertains to the heart and blood vessels. Palpitations, giddiness, and high and low blood pressure are some common cardiovascular chief complaints. High blood pressure is also called hypertension. Hypertension is associated with heart disease. Patients present with fainting, dizziness, headache, fatigue, shortness of breath, and palpitations. Besides, hypertension might be a sign of an underlying serious illness. Nowadays, many patients suffering from hypertension are under 40. It suggests that blood pressure be checked regularly in young adults. Age, family history, stress, sedentary lifestyle, excessive alcohol or smoking, and increased salt intake are some risk factors. Lifestyle modifications and medications are the mainstay of the treatment.

7. Neurological: Headache, depression, anxiety, dizziness, and paralysis are chief neurological complaints.

• Headaches are very disabling. They are often underdiagnosed and mismanaged. A good history is essential in the treatment. It is because the majority of headaches are due to a primary headache disorder. Primary headache disorder is one without any identifiable cause on examination and investigations. A common example is migraine. Secondary headaches are accompanied by an underlying diagnosis.
• Depression and anxiety are mood disorders. Depression is a continuous feeling of sadness. Loss of interest in activities, tiredness, sleep disorders, loss of appetite, frustration, and slow and troubled thinking are the outcomes. Chronic depression also initiates suicidal thoughts.
• Paralysis renders the person unable to make voluntary movements. It is a neurological disorder symptom.
• Dizziness is a common complaint in older individuals. Apart from neurological causes, it can occur as a symptom in cardiovascular, eye, and inner ear conditions. A referral to the specialist is required to arrive at the diagnosis.

8. Dermatological: The skin is the body’s largest organ. Common primary skin complaints are itching, rash, redness, and swelling. Itchy skin is also called pruritis. It is an irritating sensation. Patients must seek treatment if the itching is more than two weeks, is severe, affects the whole body, sudden in onset, and is accompanied by sweating, fever, and weight loss. The causes can be skin conditions, internal diseases, nerve conditions, psychiatric illnesses, and allergies. The treatment depends upon the condition’s severity.

9. Sexual: Vaginal discharge and irregular periods (menstruation) are some chief sexual complaints. Vaginal discharge is a frequent issue among women. Chlamydia, gonorrhea, and trichomoniasis (sexually transmitted infections, STIs) are one of the causes. Candidiasis and bacterial vaginosis alter the normal vaginal microorganisms. The World Health Organization (WHO) advises treatment for all these conditions in vaginal discharge patients.

Conclusion

PHC is not organized in developing countries. It is because the population faces socioeconomic inequality, low importance of primary prevention, and a lack of national implementation schemes for common complaints and diseases. However, advances in research, medical education, and awareness can be instrumental in the same.