ABSTRACT : Consensus about Gut Feelings in France

WONCA 2009

Background : GPs sometimes base their clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice. Research into the significance of this phenomenon with focus groups and Delphi consensus procedure in the Netherlands provided a concept of gut feelings in general practice: a sense of alarm, a sense of reassurance and several determinants.

Research question: Which consensus on gut feelings in general practice in France can be obtained, using the Dutch results and the same methods?

Method: Translation of the 7 Dutch defining statements about gut feelings conducted as forward-backward translation. Qualitative research including a Delphi consensus procedure with a heterogeneous sample of 34 French GPs involved in university educational or research programmes, included by a randomised selection of the associated teachers’ list of General practice in France.

Results: After three Delphi rounds, we found 70% or greater agreement on every of the ten proposed statements. A “sense of alarm” means that the GP gets the feeling something is wrong with the patient and he therefore needs to initiate specific management to prevent health problems. A “sense of reassurance” is defined as coherence between the patient’s complaints and the doctor’s clinical observations. Though the GP lacks objective facts, he feels confident, yet with caution, about the management of the patient’s situation. Many similarities can be found between the Dutch and the French defining statements, with a reservation on the “sense of reassurance”, which French GPs seem to feel more cautious about.

Conclusion: The “sense of alarm” and the “sense of reassurance” are well-defined concepts also in France, with many similarities between the Dutch and the French statements. This seems to indicate that gut feelings is a self contained concept.

Coppens M, Gras D, Coblentz-Baumann L, Mercier A, Le Reste J.Y.