Do 'gut feelings' have a place in patient care?

Parental concern can impact physician's intuitive feelings

A new study in BMJ suggests that physicians should listen to that "gut feeling" that something may be wrong when treating children with no obvious signs of a serious infection.

A growing number of studies have questioned the value of physicians' intuitions, but they have mostly been based on shaky understandings of gut feelings. In this latest study, Radcliffe Observatory Quarter researchers aimed to identify the basis of these intuitive feelings and their impact on care.

To do so, the researchers studied 3,369 cases of children who reported feeling sick.

They found that the clinician's gut feeling that the patient was ill was strongly correlated to the likelihood that the child had a severe infection. Among the 21 children who were later admitted to the hospital with a serious infection such as pneumonia, physicians reported a gut feeling that something was wrong for 15.

The researchers found that the likelihood of reporting a gut feeling that differed from clinical evidence decreased by 5% with each additional year a physician had been practicing medicine. 

When physicians were asked more specifically what constituted a gut feeling, they said they became concerned if the patient reported convulsions, irregular breathing, and weight loss. They also became concerned if the child's parent said the illness was unusual or different from illnesses in the past.

"The observed association between gut feeling and clinical markers of serious infection means that by reflecting on the genesis of their gut feeling, clinicians should be able to hone their clinical skills," the researchers wrote in the study.

Moreover, medical training should emphasize the potential value of gut feelings, the study says (Walsh, MedPage Today, 9/25; Bardin, "Shots," Los Angeles Times, 9/25).

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