Gut feelings of patients: do they influence their general practitioner’ diagnostic reasoning?

Tuesday, December 13th, 2016

The first step in the development of a gut feelings questionnaire for patients

An abstract accepted for a presentation on the Clinical Decision Making workshop in Bergen (Norway, 23-25th March 2017) and on the EGPRN-conference in Riga (May 2017)

Introduction: General Practitioners (GPs) recognize the role of gut feelings (GF) in their diagnostic reasoning , using a typical expression in their own language which refers to a bodily sensation. Dutch medical disciplinary tribunals consider the timely development of GF to be an element of the professional standard of doctors. Two kinds of GF emerge from a web of determinants: a sense of alarm (SA) and a sense of reassurance (SR). SA stimulates GPs to formulate and weigh up working hypotheses with a possible serious outcome . SR means that a GP feels secure about further management and course of a patient’s problem, even though he/she is not certain about the diagnosis. GF arise from the interaction between a GP’s knowledge and experience, and information about the patient, and can be understood as a kind of intuition. A consensus on seven statements about GF was the fundament for a short, validated questionnaire exploring GPs’ GF at the end of the consultation.

But what about the GF of patients? Research suggests that the gut feelings of patients also matter in predicting serious health problems of patients and diagnostic reasoning of their physicians. The feeling of parents that there is something wrong with their child appeared to be a strong predictor for a serious disease. However, an instrument measuring patients’ GF is lacking. Therefore, we aim to compose and validate a GF questionnaire for patients. We made a first step by exploring the experience of GPs and practice-nurses with their patients’ GF.

Research questions: What phrases and expressions do patients use in their communication when they experience a GF? What is the significance of patients’ GF for GPs and practice-nurses? What kind of action do the last ones take after acknowledging a patient’s GF?

Methods: We interviewed GPs (N=12), practice-nurses (N=16) and practice-secretaries (N=5) in single and in group practices in the Netherlands and Belgium. A thematic content analysis of the verbatim text was performed.

Results: We found that the participants recognized patients’ GF and we collected many different wordings and expressions used by patients to express their GF. We found some indications that a patient’s GF influences a GP’s decision-making process. Participants took their patients’ GF seriously, particularly when expressed by a parent or care provider about their child. Because of their knowledge and experience, the GF concept of GPs seemed to be richer than the patients’ GF concept but not fundamentally different. In Belgium, patients seemed to be more reserved to communicate their gut feelings to their GP. Flemish GPs said that patients often expressed their gut feelings in a non-verbal way.

Discussion: The first step in the development of a GF questionnaire for patients was successful. Next purposefully selected patients will be interviewed about their GF. Based on all data we might be able to compose a short questionnaire to determine the presence or absence of a patient’s GF.

Erik Stolper, Paul Van Royen, Margje van de Wiel, Loes van Bokhoven and Geert Jan Dinant.