'I've been bleeding from the bowel'.

BACKGROUND

Much undifferentiated illness is seen in general practice. Patients with a vague feeling of general unwellness may have multiple unrelated problems, serious underlying pathology, definite but indefinable pathology, and/or illness of psychological origin.

OBJECTIVE

This article looks at an approach to a patient who complains of tiredness but also has the 'red flag' symptom of 'bleeding from the bowel'.

DISCUSSION: Awareness of individual emotional and contextual issues is crucial to achieving a successful outcome. Careful history, examination and investigation are essential. Spreading assessment and management over several consultations can help achieve this. Organising principles such Murtagh's safe diagnostic strategy and the BATHE framework can help guide clinical thinking.