Embracing complexity with systems thinking in general practitioners’ clinical reasoning helps handling uncertainty

Thursday, February 18th, 2021

Clinical reasoning in general practice is increasingly challenging because of the rise in the number of patients with multimorbidity. This creates uncertainty because of unpredictable interactions between the symptoms from multiple medical problems and the patient’s personality, psychosocial context and life history. Case analysis may then be more appropriately managed by systems thinking than by… read more

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How child health care physicians struggle from gut feelings to managing suspicions of child abuse

Wednesday, January 13th, 2021

Abstract Aim We examined how gut feelings of child health care physicians’ (CHCPs) contribute to the development of a suspicion of child abuse, how they act upon this suspicion and what barriers they experience in their management. To gain insight into the youth health care chain, we compared the diagnostic reasoning and management regarding this… read more

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Gut feelings in obstetrics and midwifery: the role of intuition in deciding when to perform cesarean section during labor

Tuesday, July 28th, 2020

Abstract Purpose: To describe the role of intuition for maternity care workers in deciding when a cesarean section should be advised during labor. Material and methods: Focus group discussions with midwives and gynecologists, and nonparticipating observation at an obstetric ward. Results: The decision about when to propose a cesarean section during labor is the result… read more

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Medical disciplinary boards on gut feelings of patients

Thursday, July 23rd, 2020

Dutch medical disciplinary boards consider physicians’ gut feelings an element of the professional standards. Some indications can be found in the international literature suggesting intuitive feelings of unease of patients or their relatives can also contribute to adequate diagnostics. What is the view of disciplinary boards on this? A search in the disciplinary boards’ database… read more

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Complexity in general practice

Monday, June 22nd, 2020

Uncertainty and unpredictability are features of general practice despite all efforts to decrease them by guidelines and decision support tools. A great many medical problems are simple or complicated, and guidelines support GPs to find the best solutions. In cases with multimorbidity, however, medical problems are complex and not easy to deal with. In simple… read more

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Gut feelings of the general practitioner when confronted with dyspnoea and/or chest pain: a prospective observational study

Sunday, June 21st, 2020

Objective Dealing with uncertainty is an important part of the decision-making process of general practitioners (GPs). Research shows GPs think ‘gut feelings’ are a relevant phenomenon in the context of this decision-making process. A questionnaire was developed to determine the presence or absence of gut feelings in diagnostic reasoning. Chest pain and shortness of breath… read more

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GPs’ suspicion of child abuse: how does it arise and what is the follow-up?

Sunday, April 26th, 2020

Background: Child abuse is widespread, occurs in all cultures and communities, remains undiscovered in 90% of cases and has serious long-term effects. Physicians generally underidentify and underreport child abuse. To understand this low reporting rate and how the suspicion of child abuse arises, we examined GPs’ experiences. Research questions: How does the suspicion of child… read more

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Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

Thursday, February 27th, 2020

Abstract Objectives Dyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner’s (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense… read more

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Prevalence and diagnostic value of GPs’ gut feelings for cancer and serious diseases: protocol for a prospective observational study of diagnostic validity

Saturday, November 9th, 2019

Abstract Introduction Cancer diagnosis in primary care is an important challenge for general practitioners (GPs) due to the relatively low frequency of any single type of cancer and the heterogeneous signs and symptoms that can be present. In addition to analytical reasoning, GPs may become aware of gut feelings (GFs) as they suspect that a… read more

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Role of intuitive knowledge in the diagnostic reasoning of hospital specialists: a focus group study

Tuesday, January 29th, 2019

Abstract Background and objective Intuition is an important part of human decision-making and can be explained by the dual-process theory where analytical and non-analytical reasoning processes continually interact. These processes can also be identified in physicians’ diagnostic reasoning. The valuable role of intuition, including gut feelings, has been shown among general practitioners and nurses, but… read more

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