'Gut feelings' experienced by GPs play a substantial role in their diagnostic reasoning process, but always in combination with analytical reasoning. Gut feelings can be separated into the sense of alarm and the sense of reassurance. Researchers writing in the open access journal BMC Family Practice worked with 27 medical opinion leaders to closely define the concepts, which will allow future research to evaluate the effectiveness of this 'gut-compass'.
Erik Stolper, from Maastricht University, The Netherlands, worked with a team of researchers to carry out the consensus procedure. He said, "Uncertainty and unpredictability are common phenomena in general practice. Although gut feelings play a role in dealing with this uncertainty, studies about their validity are lacking. In order to facilitate such research, we've created a well-supported definition of the two types of gut feeling, alarm and reassurance".
The researchers' panel eventually concluded that a sense of alarm means that a GP perceives an uneasy feeling, as they are concerned about a possible adverse outcome. They might not have found any specific indications yet; it is a sense of 'there's something wrong here'. Stolper said, "A 'sense of alarm' activates the diagnostic process by stimulating a GP to formulate and weigh up working hypotheses that might involve a serious outcome. If possible, the GP needs to initiate specific management to prevent serious health problems. The sense will decrease as the diagnosis and the right management become clearer".
The sense of reassurance means that a GP feels secure about the further management and course of a patient's problem, even though he/she may not be certain about the diagnosis: everything fits in.
Speaking about the possible applications of these findings, Stolper said, "Our next step will be to construct and validate a questionnaire as a tool to evaluate gut feelings as well as the diagnostic work-up and the contribution of major potential determinants like experience and contextual knowledge. Actually, we aim to enhance the positive effects of gut feelings in the diagnostic process and to reduce their potential undesirable effects".
Notes to Editors
1. Consensus on gut feelings in general practice
Erik Stolper, Paul Van Royen, Margje Van de Wiel, Marloes Van Bokhoven, Paul Houben, Trudy Van der Weijden and Geert Jan Dinant
BMC Family Practice (in press)
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2. BMC Family Practice is an open access journal publishing original peer-reviewed research articles in all aspects of primary health care, including clinical management of patients, professional training, shared decision making, and the organisation and evaluation of health care in the community. BMC Family Practice (ISSN 1471-2296) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE, Current Contents, Thomson Reuters (ISI) and Google Scholar.
3. Uncertainty and unpredictability are common phenomena in general practice and will be major themes at the WONCA conference in Basel, 16-19 September 2009 (www.woncaeurope2009.org).
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