Abstract WONCA 2007
Gut feelings in General Practice: a practical definition

Background and aims:
GPs sometimes base clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice. It is not known what the impact is of this non-analytical aspect of GPs’ diagnostic decision-making The aim of this study is to contribute to a practical and valid definition of gut feelings and to assess its main determinants.

Method:
Qualitative study with 4 focus groups (n= 28 GP’s), analysed by content using a grounded theory approach. Delphi consensus procedure with 27 educational and research experts in general practice

Results:
Gut feelings are common in daily practice and are considered useful. There are two types of gut feelings: a sense of reassurance and a sense of alarm. In the former case, a GP is sure about prognosis and therapy. A sense of alarm means that a GP distrusts the situation without knowing why: some kind of intervention seems necessary to prevent severe health-problems. We identified the main determinants of gut feelings: fitting, alerting and interfering factors, sensation, validity, contextual knowledge, medical education, experience and personality. Consensus about 7 of the 11 proposed statements on gut feelings has been obtained.

Conclusions:
Gut feelings act as a compass in situations of uncertainty. The consensus can be used as a conceptual instrument for further studies on the topic. Research into the contributions of individual determinants and into the test properties of gut feelings, is necessary to make the concept suitable for medical education.

P. Van Royen, C.F. Stolper, M.A. Van Bokhoven, P. Houben, M. Van de Wiel,  T. Van der Weijden, G.J. Dinant