Should we trust the doctor’s gut feeling?
As I recently moved from country WA to the beautiful Sunshine Coast – which has also increased my commuting time – I have more time to listen to podcasts. I particularly enjoy BBC’s Inside Health with GP Dr Mark Porter.
One of the recent topics on the show was ‘gut feeling’. Dr Porter interviewed GP Dr Ann Van den Bruel who has done some fascinating research on this topic.
In one study, published in BMJ, Van den Bruel was able to calculate the diagnostic accuracy of the doctor’s instinct and found that it is one of the most powerful predictors of, for example, serious infections in children. One of the recommendations of the authors is:
We should certainly make clear when teaching that an inexplicable (or not fully explicable) gut feeling is an important diagnostic sign and a good reason for seeking the opinion of someone with more expertise or scheduling a review of the child.
Invaluable advice, and something most experienced GPs will do routinely. Van den Bruel: “It’s not a hundred per cent right but the chance that something serious is going on is much higher when a doctor has a gut feeling.”
It’s great to hear that trusting our gut instinct may not be unscientific after all, and will add to the quality of patient care.
Hi Edwin
It is an interesting question. How good is a “gut feeling”?
I wrote a piece on this a while back – my conclusion is that we should not rely on our gut for serious problems – best to use simple, “dumb” algorithms.
Too many biases in human brains to be a robust tool!
Having said that – if your gut says: there is something wrong – then it is a good idea to act on that. Worse case is you overcall it
But trusting your gut to say: “all is fine ” is fraught with peril in my opinion. Especially when dealing with potential badness – eg. Sick baby / fever
In that instance we should use simple, dumb algorithms – more objective, less bias
Thanks
Casey
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Good point. The study referred to found that the GPs gut feelings that something was wrong even when unexplained by clinical assessment had a high specificity and high positive likelihood ratio for serious infectious illness in children – I guess that means after having followed the usual algorithms you refer to. Interestingly, the authors also thought that in more experienced clinicians the gut feeling is assimilated into the clinical assessment.
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Reblogged this on FOAM4GP.
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Gut feeling is nothing more than recognising the conglomerate of cues one gets when with a patient and then not being able to articulate your assessment. IT becomes a “gut feeling” because you know something is not right just “can’t put your finger on it” yet.
Gut feeling, “intuition” is nothing more or less than good observation and responding, albeit in a less than ideal way. It is nothing magical that replaces good history taking and observation.
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