Consensus on gut feelings in general practice

Stolper, Erik; Royen, Paul Van; Wiel, Margaretha W. J. van de; Bokhoven, Marloes van; Houben, Paul; Weijden, Trudy van der; Dinant, Geert Jan

doi:10.1186/1471-2296-10-66

Cited by 84 publications

(97 citation statements)

References 10 publications

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“…8,9 It was found to be the most discriminative 'test' in diagnosing adult patients with chest pain, 4 or ill children. 1 Nobody suggests that gut feeling is a special paranormal gift of GPs, 10 although the finding could not be confirmed in patients with chest pain examined in a university teaching hospital's emergency department.…”

Section: Gut Feelingmentioning

confidence: 99%

Dealing with low-incidence serious diseases in general practice

Buntinx¹,

Mant²,

Bruel³

et al. 2011

Br J Gen Pract

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Cost-effective health care depends on high-quality triage. The most challenging aspect of triage, which GPs confront on a regular basis, is diagnosing rare but serious disease. Failure to shoulder any risk in this situation overloads the health system and subjects patients to unnecessary investigation. Adopting too high a risk threshold leads to missed cases, late diagnosis, and sometimes avoidable death. It also undermines the credibility of primary care practitioners. Quantification of diagnostic risk suggests there is a potential risk gap between the maximum certainty with which GPs can assess the risk of serious disease at presentation and the minimum certainty required by many health systems for further investigation or hospital referral. Physician gutfeeling and diagnostic safety netting are often employed to fill the gap. Neither strategy is well defined or well supported by evidence. It should be possible to reduce the diagnostic risk gap cost-effectively by adopting more explicit diagnostic algorithms and providing better GP access to new diagnostic technologies. It is also essential, given the decreasing experience of triage clinicians employed in a number of countries, that a teachable evidence base is constructed for gut feeling and diagnostic safety netting. However, this construction of an evidence base requires very large-scale studies, and the global primary care research community remains small. The challenge therefore needs to be met by urgent and effective international collaboration.

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Section: Gut Feelingmentioning

confidence: 99%

Dealing with low-incidence serious diseases in general practice

Buntinx¹,

Mant²,

Bruel³

et al. 2011

Br J Gen Pract

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“…They may act as a compass, steering GPs through busy office hours and enabling them to handle complex problems. Two types of gut feelings can be discerned: a sense of alarm and a sense of reassurance 16. The ‘sense of alarm’ implies that a GP worries about a patient’s health status, even though they have found no specific indications yet; it is the sense of ‘there’s something wrong here.’ It means that the GP needs to initiate specific management to prevent serious health problems.…”

Section: Introductionmentioning

confidence: 99%

Gut Feelings as a Third Track in General Practitioners’ Diagnostic Reasoning

et al. 2010

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BackgroundGeneral practitioners (GPs) are often faced with complicated, vague problems in situations of uncertainty that they have to solve at short notice. In such situations, gut feelings seem to play a substantial role in their diagnostic process. Qualitative research distinguished a sense of alarm and a sense of reassurance. However, not every GP trusted their gut feelings, since a scientific explanation is lacking.ObjectiveThis paper explains how gut feelings arise and function in GPs’ diagnostic reasoning.ApproachThe paper reviews literature from medical, psychological and neuroscientific perspectives.ConclusionsGut feelings in general practice are based on the interaction between patient information and a GP’s knowledge and experience. This is visualized in a knowledge-based model of GPs’ diagnostic reasoning emphasizing that this complex task combines analytical and non-analytical cognitive processes. The model integrates the two well-known diagnostic reasoning tracks of medical decision-making and medical problem-solving, and adds gut feelings as a third track. Analytical and non-analytical diagnostic reasoning interacts continuously, and GPs use elements of all three tracks, depending on the task and the situation. In this dual process theory, gut feelings emerge as a consequence of non-analytical processing of the available information and knowledge, either reassuring GPs or alerting them that something is wrong and action is required. The role of affect as a heuristic within the physician’s knowledge network explains how gut feelings may help GPs to navigate in a mostly efficient way in the often complex and uncertain diagnostic situations of general practice. Emotion research and neuroscientific data support the unmistakable role of affect in the process of making decisions and explain the bodily sensation of gut feelings.The implications for health care practice and medical education are discussed.

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“…That uneasy feeling experienced by the FPs interviewed matched the sense of alarm described in the “gut feeling” concept [20]. This sense of alarm implies that an FP worries “about a patient's health status, even though he/she has found no specific indications yet”; it is a sense that ‘there's something wrong here’” [20].…”

Section: Discussionmentioning

confidence: 73%

“I Can't Find Anything Wrong: It Must Be a Pulmonary Embolism”: Diagnosing Suspected Pulmonary Embolism in Primary Care, a Qualitative Study

et al. 2014

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BackgroundBefore using any prediction rule oriented towards pulmonary embolism (PE), family physicians (FPs) should have some suspicion of this diagnosis. The diagnostic reasoning process leading to the suspicion of PE is not well described in primary care.Objectiveto explore the diagnostic reasoning of FPs when pulmonary embolism is suspected.MethodSemi-structured qualitative interviews with 28 FPs. The regional hospital supplied data of all their cases of pulmonary embolism from June to November 2011. The patient's FP was identified where he/she had been the physician who had sent the patient to the emergency unit. The first consecutive 14 FPs who agreed to participate made up the first group. A second group was chosen using a purposeful sampling method. The topic guide focused on the circumstances leading to the suspicion of PE. A thematic analysis was performed, by three researchers, using a grounded theory coding paradigm.ResultsIn the FPs' experience, the suspicion of pulmonary embolism arose out of four considerations: the absence of indicative clinical signs for diagnoses other than PE, a sudden change in the condition of the patient, a gut feeling that something was seriously wrong and an earlier failure to diagnose PE. The FPs interviewed did not use rules in their diagnostic process.ConclusionThis study illustrated the diagnostic role of gut feelings in the specific context of suspected pulmonary embolism in primary care. The FPs used the sense of alarm as a tool to prevent the diagnostic error of missing a PE. The diagnostic accuracy of gut feelings has yet to be evaluated.

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Consensus on gut feelings in general practice

Cited by 84 publications

References 10 publications

Dealing with low-incidence serious diseases in general practice

Dealing with low-incidence serious diseases in general practice

Gut Feelings as a Third Track in General Practitioners’ Diagnostic Reasoning

“I Can't Find Anything Wrong: It Must Be a Pulmonary Embolism”: Diagnosing Suspected Pulmonary Embolism in Primary Care, a Qualitative Study

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