Creating space for gut feelings in the diagnosis of cancer in primary care

[摘要] INTRODUCTION In a series of recent BJGP articles, our group has explored GPs’ gut feelings in relation to the decision to investigate for cancer.1–3 Our first article, a systematic review and meta-analysis, indicated that GPs’ gut feelings represent a rapid summing-up of multiple, often subtle, verbal and non-verbal cues noted in the consultation. This summing-up could lead to a sense that a patient was seriously unwell, and when GPs had this gut feeling the odds of a cancer diagnosis were four times higher than when no gut feeling was recorded.1 Two interview studies then explored gut feelings with GPs and patients, respectively, who had either made referrals or been referred for cancer investigation.2,3 Both groups perceived gut feeling was gradually honed with increasing clinical experience and personal experience of the patient. Patients said that they thought the ‘thorough GP’ would validate this short-cut in clinical reasoning through further evidence gathering. GPs reported building a case for their gut feelings by gathering additional clinical information and by discussing the case with colleagues, rather than acting on them in isolation. Both groups shared concerns about whether acting on gut feelings would lead to unnecessary referrals and made the GP more vulnerable to litigation, and commented on the tension between using them in the changing landscape of primary care. At first glance, gut feelings, with their emphasis on subtleties and individual knowledge, may seem incompatible with technology, algorithms, and protocolised practice, but we consider whether digital health technology might support, not supplant, gut feelings (Box 1).

[学科分类] 卫生学