Many GPs experience so-called gut feelings in their diagnostic reasoning about patients, a specific kind of intuitive feelings usually confined to prognostic assessments of the patient’s situation and often accompanied by bodily sensations.(1;2) These may act as a compass, steering GPs through busy office hours and enabling them to handle complex problems.(3) Two types of gut feelings can be discerned: a sense of alarm and a sense of reassurance.(4) The sense of reassurance means that a GP feels confident about his/her management plan and/or about the outcome of a patient’s problem, even though he/she may not be certain about the diagnosis: it all adds up. A ‘sense of alarm’ implies that a GP worries about a patient’s health status, even though he/she has found no specific indications yet; it is a sense of ‘there’s something wrong here’. The sense of reassurance and the sense of alarm constitute a dynamic element in a GP’s diagnostic process.

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The complete Dutch-Flemish consensus (4) on gut feelings is as follows:

Sense of alarm

• Statement 1a: A ‘sense of alarm’ means that a GP perceives an uneasy feeling as he/she is concerned about a possible adverse outcome.

 

• Statement 3: A ‘sense of alarm’ implies that a GP worries about a patient’s health status, even though he/she has found no specific indications yet; it is a sense of ‘there’s something wrong here’.

 

• Statement 4: A ‘sense of alarm’ means that, if possible, the GP needs to initiate specific management to prevent serious health problems.

 

• Statement 2: The ‘sense of alarm’ activates the diagnostic process by stimulating a GP to formulate and weigh up working hypotheses that might involve a serious outcome.

 

• Statement 9: A ‘sense of alarm’ will decrease as the diagnosis and the right management become clearer.

 

Sense of reassurance

• Statement 5: A ‘sense of reassurance’ means that a GP feels secure about the further management and course of a patient’s problem, even though he/she may not be certain about the diagnosis: everything fits in.

 

After a Delphi consensus procedure, French GPs found the following nine statements about the sense of reassurance and the sense of alarm (5;6):

• Statement 1a: The sense of alarm is particularly related to the non-concordance between the patient’s complaints and the signs (semiological or clinical) found by the GP.

 

• Statement 1b: The sense of reassurance is linked to the similarity between the patient’s symptoms and the clinical picture found by the doctor.

 

• Statement 2: The sense of alarm triggers the general practitioner’s diagnostic process, pushing him to formulate and test hypotheses linked to serious illnesses which could have serious consequences for the patient.

 

• Statement 3: The sense of alarm implies that the GP mistrusts the patient’s health status even though he does not have any objective arguments – something is wrong here.

 

• Statement 4: The sense of alarm means that the GP will go further in his diagnostic or communicational process until he understands the clinical picture and / or the patient’s fears.

 

• Statement 5: The sense of reassurance means that the GP, even though he lacks objective data, feels sufficiently sure of himself to be able to propose an adapted management plan. This certitude is, however, temporary, as he needs to be cautious and prepared to review his position if in any doubt.

 

• Statement 6: The sense of reassurance means that the GP is sufficiently sure of himself to start the patient’s treatment.

 

• Statement 7: The sense of alarm and the sense of reassurance indicate the GPs conviction, both concerning the coherence of the clinical picture and the quality of the doctor patient relationship, within the clinical picture.

 

• Statement 8: The sense of alarm and the sense of reassurance help the GP in his decision-making in uncertain clinical situations.

 

(1) Stolper CF, Van Royen P, Dinant GJ. The ‘sense of alarm’ (‘gut feeling’) in clinical practice. A survey among European general practitioners on recognition and expression. Eur J Gen Pract 2010;(2):72-4.

(2) Stolper CF, Van Bokhoven MA, Houben PHH, Van Royen P, Van de Wiel M, Van der Weijden T, et al. The diagnostic role of gut feelings in general practice. A focus group study of the concept and its determinants. BMC Fam Pract 2009 Feb 18;10(17).

(3) Stolper CF, Van de Wiel M, Van Royen P, Van Bokhoven MA, Van der Weijden T, Dinant GJ. Gut feelings as a third track in general practitioners’ diagnostic reasoning. J Gen Intern Med 2011;26(2):197-203.

(4) Stolper CF, Van Royen P, Van Bokhoven MA, Houben PHH, Van de Wiel M, Van der Weijden T, et al. Consensus on gut feelings in general practice. BMC Family Practice 2009, 10:66 2009.

(5) Coppens M, Barraine P, Barais M, Nabbe P, Berkhout C, Stolper CF, et al. L’intuition en médecine générale: validation francaise du consensus néerlandais ‘gut feelings’. Exercer 2011;22(95):16-20.

(6) Le Reste JY, Coppens M, Barais M, Nabbe P, Le FB, Chiron B, et al. The transculturality of ‘gut feelings’. Results from a French Delphi consensus survey. Eur J Gen Pract 2013 Apr 16.