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

Abstract

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.

EBM and gut feelings

“…The GP's gut feeling is, and we agree with Stolper et al (2011), a very important and complex issue in GP practice. Their findings and descriptions are very interesting and of great significance when studying GP clinical practice and GP training.…”

Diagnosing headache in primary care: a qualitative study of GPs’ approaches

“…18,19 This contextual information feeds into both analytical and non-analytical diagnostic reasoning. 20 Most GPs regarded the first patient impression as an important element. Studies mainly conducted with simulated patients showed how different patient characteristics influenced physician's behaviour.…”

“…Stolper et al confirm the important role of gut feelings together with analytical reasoning and personal experience in GPs' diagnostic reasoning. 20 The initial steps of the diagnostic process are often non-analytical or intuitive 24 before, in a further step, one or several hypotheses are generated. 25 This process is reflected in these data.…”

Cancer suspicion in general practice: the role of symptoms and patient characteristics, and their association with subsequent cancer

“…There is current interest in the physician's gut feeling 12 based on the hypothesis that analytical and non-analytical processes interact during the doctor's diagnostic work. 13 However, gut feeling sometimes may be based on clinical observations rather than vague impressions, that is, general appearance, breathing pattern, and weight loss.…”