Clinician gut feelings are an acknowledged part of clinical decision making but the scientific literature lacks consistency. This systematic review led by Oxford University researcher Dr Claire Friedmann Smith, however, found that GP gut feelings are predictive of cancer.
Gut feelings are the multiple verbal and non-verbal patient cues picked up by the doctor and seem to be reliant on continuity of care and clinical experience.
However, they are often poorly recorded or inaccessible to researchers.
A systematic review published in BJGP including 12 papers and four web resources described varied conceptualisations of gut feeling.
These were often initially associated with patients being unwell rather than with a suspicion of cancer and were commonly experienced in response to symptoms and non-verbal cues.
The pooled odds of a cancer diagnosis were four times higher when gut feelings were recorded and 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.
Commenting, co-author Dr Brian Nicholson, a GP and Clinical Lecturer in the Nuffield Department of Primary Care Health Sciences, 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 study highlights the art of General Practice - this gut feeling is something that GPs develop over several years as they build experience and have contact with patients. As well as the hard and fast symptoms of cancer, GPs can pick up a lot from the way a patient behaves.
"It could be that the patient is sitting uncomfortably, talking differently, or the way they get up out of their chair in the waiting room. They are all subtle cues that you pick up while seeing a patient which form part of a bigger picture that could lead to a cancer referral."
Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence
Claire Friedemann Smith, Sarah Drew, Sue Ziebland and Brian D Nicholson
British Journal of General Practice 24 August 2020; bjgp20X712301. DOI: https://doi.org/10.3399/bjgp20X712301