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Open Access Highly Accessed Research article

Consensus on gut feelings in general practice

Erik Stolper1*, Paul Van Royen2, Margje Van de Wiel3, Marloes Van Bokhoven1, Paul Houben1, Trudy Van der Weijden1 and Geert Jan Dinant1

Author Affiliations

1 School for Public Health and Primary Care (CAPHRI), Department of General Practice, Maastricht University, Maastricht, The Netherlands

2 Department of General Practice, University of Antwerp, Antwerp, Belgium

3 Department of Work and Social Psychology, Maastricht, Maastricht University, The Netherlands

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BMC Family Practice 2009, 10:66  doi:10.1186/1471-2296-10-66

Published: 17 September 2009

Abstract

Background

General practitioners sometimes base clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice. Research to validate the determinants and to assess the test properties of gut feelings requires precise and valid descriptions of gut feelings in general practice which can be used as a reliable measuring instrument. Research question: Can we obtain consensus on descriptions of two types of gut feelings: a sense of alarm and a sense of reassurance?

Methods

Qualitative research including a Delphi consensus procedure with a heterogeneous sample of 27 Dutch and Belgian GPs or ex-GPs involved in academic educational or research programmes.

Results

After four rounds, we found 70% or greater agreement on seven of the eleven proposed statements. A "sense of alarm" is defined as an uneasy feeling perceived by a GP as he/she is concerned about a possible adverse outcome, even though specific indications are lacking: There's something wrong here. This activates the diagnostic process by stimulating the GP to formulate and weigh up working hypotheses that might involve a serious outcome. A "sense of alarm" means that, if possible, the GP needs to initiate specific management to prevent serious health problems. A "sense of reassurance" is defined as a secure feeling perceived by a GP about the further management and course of a patient's problem, even though the doctor may not be certain about the diagnosis: Everything fits in.

Conclusion

The sense of alarm and the sense of reassurance are well-defined concepts. These descriptions enable us to operationalise the concept of gut feelings in further research.