Diagnostic accuracy of general practitioners' "gut feelings"

Clinical Question

How often are gut feelings used by primary care physicians, and how often does a sense of alarm predict serious illness?

Bottom line

A diagnosis can be made via 2 different approaches: a slow, logical, step-by-step reasoning process, or (more often) a fast, intuitive approach based on recognition of patterns of illness seen in previous cases. In this study, Spanish general practitioners reported using the latter approach, their gut feeling, in almost all their consultations with patients who presented with a new concern. The physician's sense of alarm correctly predicted cancer or another serious disease 12% of the time, but the lack of it was correct 98% of the time. This is not the first study to show the role of gut feelings in the diagnostic process. 1c

Study design: Cohort (prospective)

Funding: Foundation

Setting: Outpatient (primary care)

Reviewer

Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA


Discuss this POEM


Comments

George Manuel Burden

Gut feeling

This confirms my own practice where a sense of something wrong will frequently turn up serious issue.

Anonymous

gut feelings

Gut feelings are based on the attentive physician realizing something's wrong, and beginning the diagnostic path is a god thing. I was involved recently in such a case where malignancy was suspected but another, treatable condition was instead discovered. The patient needed a workup regardless.

Eric Nicholas Kaziuka

GP "gut feelings"

Wording of the article implies that gut feelings are not a good thing. Firstly, gut feelings allow you to then step back and take a "logical" approach. Secondly, 4.6 of 22 is 21% (not 12%) and thus is correct in 1 of 5 patients. If years of practice were factored into this, I think "gut Feelings" would be even more accurate

Anonymous

gut feelings re diagnosis

using diagnostic testing and logical approach better

Arup Kumar Dhara

Impact assessment

Very good

Anonymous

Diagnostic sérieux

Certain que le présentiment est utile dans les présentations plus avancées, mais question de se demander notre capacité à prédire la maladie grave dans les premières phases de maladie.