A review of 12 papers and four web resources on the issue found odds of a cancer diagnosis were four times higher when gut feelings were recorded.
The gut feeling that doctors have can be a useful tool in predicting whether a patient has cancer, according to a review. A GP’s instinct something is wrong is an acknowledged part of clinical decision making but until now there has been little scientific evidence that it matters.
A review of 12 papers and four web resources on the issue found odds of a cancer diagnosis were four times higher when gut feelings were recorded, and they became more predictive of cancer as clinical experience and familiarity with the patient increased.
Some specialists questioned the diagnostic value so some GPs ignored or omitted mentioning gut feelings in referral letters, or chose investigations not requiring specialist approval, the review found.
Gut feelings for cancer were often prompted by patterns of clinical features – commonly, symptoms – and were reported to be based on patients’ different behaviour or body language to normal. They were linked with GPs’ empathy, and developed with experience or through repetition of clinical scenarios.
Lead author Brian Nicholson, clinical researcher at the University of Oxford, said: ‘We found research that suggests that gut feelings are more effective at identifying people with cancer than the symptoms and signs used in guidelines. We wanted to understand what leads to a GP having a gut feeling in case the guidelines could be improved.
“Our findings emphasise that GPs collect and interpret a large amount of information about their patient in a short period of time. Together these pieces of information can lead to a gut feeling that something is wrong. Only some of this information is included in current guidelines.”
The Royal College of GPs said the findings, published in the British Journal of General Practice, could have major implications for Health Secretary Matt Hancock’s move towards a “Zoom first” policy in primary care.
Dr Jonathan Leach, honorary secretary of the College, said: “GPs consider a huge variety of factors when making a patient diagnosis. As well as more obvious physical symptoms, non-verbal cues can often indicate that something is wrong – not necessarily what the patient has made an appointment to speak about. This ‘gut feeling’ or intuition is something that GPs develop by having close, trusting relationships with patients that are often built over time, and isn’t something that should be ignored.
“As this paper suggests, a GP’s ‘gut feeling’ can be useful in identifying potential serious health conditions, such as cancer, even when patients don’t meet the official criteria for referral to specialist care. This is one reason why GPs need some flexibility in being able to refer patients where they are concerned as well as better access to investigations in the community, and the appropriate training to use them, so they can pursue their intuition, and take the results into account when making an informed decision to refer a patient.
“It is also something that should be considered when looking into the way patients access general practice services in the future. Remote consultations can be convenient for patients, and they have been vital in helping to stop the spread of the Covid-19 virus and keeping patients safe during the pandemic. However, they can pose challenges for GPs, not least the lack of non-verbal cues that we often use to help us make a diagnosis.
“Whilst there is a place for remote consulting in general practice, neither GPs nor patients want to see it become a totally remote service, but one where patients can choose how to access general practice according to their needs and preferences.”
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