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It occurs that a general practitioner (GP) has a feeling that something is not OK with the patient and relates the feeling to a suspected cancer diagnosis without knowing why. This gut feeling appears to be not an imprecise but nonetheless valuable instrument. In two third of the cases this gut feeling leads to a diagnosis and in one third the ultimate diagnosis is cancer.
When a patient consults a GP, not only the medical history and the clinical examination, but also intuition and experience are important to proceed to a diagnosis. The intuitive nature of gut feelings mainly functions as an alarm driving the GP to search for objective signs and symptoms to back up these feelings. Acting on gut feelings in medicine is not a novelty, it might even be expected from a GP. This assumption is strengthened by a Medical Court decision in 2008 judging that a GP unrightfully did not follow-up his gut feelings.
A study analyzing data of the Dutch Sentinel GP Network of NIVEL concerning the occurrence of gut feelings about cancer (133 cases), shows that gut feelings were triggered by unexplained weight loss, patients usually rarely consulting the GP, prolonged course of symptoms or an ‘unhealthy appearance’. Often a combination of these triggers was reported by the GP. Half of the patients was immediately referred to specialist care after GP consultation. Other common forms of follow up were additional laboratory tests, X-ray or echo examinations. A follow-up questionnaire after three months revealed that in two thirds of the patients the diagnosis was clear and in over one third of the cases the diagnosis indeed proved to be cancer. In one quarter of the patients the final diagnosis was equivalent to the anticipated diagnosis at the time of the consultation causing gut feeling.
“Especially for a disease like cancer, where early diagnosis is so important for prognosis, it may be very valuable that GPs are sensitive to gut feelings,” says NIVEL-project leader, GP and epidemiologist Gé Donker. “Often there are no objective signs. Some GPs even experience an almost physical sensation. The GP mistrusts the array of symptoms and presentation, doubts the prognosis and experiences the need for further assessment. Gut feelings may lead to a referral or further exploration, in some cases leading to a timely diagnosis and treatment.”
Dutch Sentinel GP Network
The Dutch Sentinel GP Network of NIVEL constitutes a representative group of 59 Dutch GPs in 42 practices. The population registered in the network is 0.8% of the Dutch population and is nationally representative by age, gender, regional distribution and population density. The sentinel GPs report weekly (influenza, pneumonia) or annually (whooping cough, end-of-life care, gut feeling) on the incidence of diseases, care characteristics and interventions lacking and not simply included in routine registrations. The presented analyses are stratified by gender and age group, region and population density of the practice population. The Sentinel GP Network exists since 1970.
- Ministry of Health, Welfare and Sports