Background: The Wells rule is a tool to support physicians in their decisions regarding Pulmonary Embolism (PE). The rule includes a subjective element: 3 points are allocated to the physician’s assessment whether PE is more likely than an alternative diagnosis. The diagnostic process leading to the suspicion of PE is not well described in primary care.

Research question: how family physicians (FPs) come to suspect pulmonary embolism?

Method: Semi-structured qualitative interviews with 28 FPs. The regional hospital supplied data of all their cases of pulmonary embolism from June to November 2011. The patient’s FP was identified where he/she had been the physician who had sent the patient to the emergency unit. The first consecutive 14 FPs who agreed to participate made up the first group. A second group was chosen using a purposeful sampling method.  The topic guide focused on the circumstances leading to the suspicion of PE. A thematic analysis was performed, by three researchers, using the grounded theory coding paradigm.

Results: The suspicion of pulmonary embolism arose out of four considerations: the absence of indicative clinical signs for other diagnoses than PE, a sudden change in the condition of the patient, a gut feeling that something was seriously wrong and an earlier failure to diagnose PE. The FPs interviewed did not use rules in their diagnostic process.

Conclusion: This study illustrated the role of gut feelings in the specific context of suspected pulmonary embolism in primary care. The results indicated an assumption that FPs tended to use clinical feeling rather than clinical rules when PE was suspected. The diagnostic accuracy of this aspect of gut feelings has to be evaluated before being recommended or taught. 

Abstract of a presentation at the EGPRN-conference in Malta (October 2013).

Authors : Marie Barais (presenter), Nathalie Morio, Amélie Cuzon Breton, Pierre Barraine, Amélie Calvez, Jean Yves Le Reste, Paul Van Royen and Erik Stolper and Claire Liétard.