A PhD study in the Netherlands

On 26 February 2010, Erik Stolper defended his PhD entiteld Gut Feelings in General Practice, at the Maastricht University. download Gut Feelings in General Practice (PDF – 5 MB)

A PhD study in France (Brest)


A PhD study proposal by Marie Barais, GP.

Summary of her proposal: The General Practitioners (GPs) are likely to face many diagnoses from benign to severe with the same sorts of nonspecific symptoms. Taking the wrong decision can lead to severe consequences both for the medical status of the patient and for the judicial level of the physician. Regularly GPs experience an uncomfortable feeling that something does not fit in a patient’s clinical presentation. The sense of alarm was described besides the sense of reassurance as gut feelings. This sense of alarm alerts the doctor, activates the diagnostic process and induces him or her to initiate specific management to prevent serious health problems. The sense of alarm can be seen as a control keeper in the decision-making process in general practice. Our first objective was to describe how GPs used their sense of alarm as a tool preventing error when diagnosing pulmonary embolism with a qualitative study. The second objective is to study the sensibility, specificity and likelihood ratio of the sense of alarm facing thoracic pain and or dyspnoea using a questionnaire exploring the gut feeling. The third objective is to demonstrate whether a GPs training session on medical decision making theories and risk prevention improves quality of care.

Results: Marie Barais rounded off her PhD study and defended succesfully her thesis, in Antwerp (2018-10-16) See summary Barais 03062018

A PhD study in Spain (Mallorca)


by Bernardino Oliva-Fanlo, GP, PhD student (IBSALUT, Spain) Promotors: Magdalena Esteva-Cantó, GP, PhD (Balearic Islands University, Spain)Erik Stolper, GP, PhD (Maastricht University, the Netherlands; University of Antwerp, Belgium). Contributors: Sebastià March-Llull, sociologist (Majorcan Primary Care Research Unit, Spain), Cristina Gadea-Ruiz, GP (IBSALUT, Spain) 

Summary The diagnostic process in clinical medicine has traditionally been seen from two perspectives, the hypothetical-deductive and the decision-making. There are other ways of approaching knowledge, as intuition, dual process theories and emotions, that have a role in the diagnostic process and have received attention in the medical and the psychological fields. Related to these other ways of approaching knowledge and diagnostic process are those that in the Anglo-Saxon tradition are called gut feelings (GF), defined as “useful warning light, which suddenly lights up to announce that there is something unusual” (Hull 1985).  There are expressions with similar meaning in many other languages.  We find references to these GF in fields such as nursing,  diagnosis of cancer and serious diseases in both primary and specialised care, chest pain, paediatrics and emergency care. Studies in the Netherlands have shown that there are two fundamental types of GF. On the one hand a sense of alarm as a feeling that something does not fit in that particular patient, leading to intensify medical diagnosis efforts and to be concerned about a possible serious outcome of the current episode. On the other hand a sense of reassurance when everything fits, even unknowing the precise diagnosis. Similar conclusions have been reached by studies with French GPs. We intend to research about gut feelings among Spanish GPs. First we will investigate the existence, significance, determinants and triggers of these gut feelings. We will take out a focus group study replicating Stolper et al research among Dutch GPs (Stolper et al 2009). We will compare our results with the Dutch and the French ones. After this study our project will continue with the English-Spanish translation and linguistic validation of the Gut Feelings Questionnaire (GFQ) developed by Stolper et al (Stolper et al 2013) for measuring the presence of GF in diagnostic reasoning. We will take care about including Spanish speaking GPs from the Americas in this process of linguistic validation to achieve a greater scope of the GFQ. If necessary we will also proceed to the construct validation of the Spanish version of the GFQ. Finally we foresee to take out a quantitative research using the GFQ to assess the predictive value and accuracy of the Spanish GPs gut feelings in the early diagnosis of cancer. During the development of the project and depending on the results we get we will value other possibilities (Delphi consensus study, survey among Spanish speaking GPs from Spain and the Americas…) that can help us to understand and define the phenomenon of GF among Spanish GPs.

Bernardino Oliva Fanlo published his thesis Gut Feelings in the diagnostic process of Spanish Family Physicians (June 2022), See Thesis Bernardino Oliva Fanlo

Just Worry. Exploring triggers used by nurses to identify surgical patients at risk for clinical deterioration

Gooske Douw, a nurse, defended succesfully her thesis ‘Just Worry. Exploring triggers used by nurses to identify surgical patients at risk for clinical deterioration’, in Nijmegen (2018/10/4).

From literature, it is known that nurses may have a sense of alarm earlier that vital parameters will deviate. The aim of the thesis was to explore nurses’ worry and its role in the process of early recognition of deteriorating surgical ward patients, in order to empower nursus to call for assistance at an early stage.

She first describes a systematic review of the literature on signs and symptoms underlying nurses’ worry. She summarises all signs and symptoms as 10 indicators in the Dutch-Early-Nurse-Worry-Indicator-Score (DENWIS). In the subsequent studies, she explores the occurrence of nurses’ worry with the DENWIS and the predictive value of the DENWIS compared to the EWS (Early Warning System). She concludes that nurses’ worry can be objectified and is a good predictor of deterioration in surgical patients, especially in an early phase when vital signs do not deviate from normal values. The DENWIS could contribute to clear and transparant communication during nurses’ shift handover, and doctors’ rounds, or when calling for assistance.

Please find her thesis (apart from chapter 6 because not yet published):

PhD thesis_JUST WORRY_ Gooske Douw_2018_Chapters 1-5 & 7-9