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Should you ever go with your gut feeling?
posted at 27/9/2012 12:24 PM BST
on bmj.com
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*Moderator*
Posts: 1492
First: 7/4/2011 Last: 18/6/2013 |
A new piece of BMJ research has looked at how primary care doctors who experience a “gut feeling” about serious illness when treating a child should take action upon this feeling and not ignore it. Gut feeling was defined as “intuitive feeling that something was wrong even if the clinician was unsure why”. The paper wanted to look at serious infections, which can be easily missed in clinical assessments and assess the diagnostic value of a clinician’s intuitive feeling that something is wrong, even when other examinations suggest otherwise. Out of the 3369 children assessed as having a non-severe illness at the time of consultation, six (0.2%) were later admitted to hospital with a serious infection. Results show that acting on gut feeling had the potential to prevent two of the six cases being missed at the cost of 44 false alarms, but that these were not “unmanageable”. The probability of a serious infection decreased from 0.2% to 0.1% when gut feeling was absent. In fact, 21 out of the 3890 children were eventually admitted to hospital with a serious infection and nine were not referred at first contact. However, in four of the nine children, the doctor had a gut feeling that something serious was wrong.
The feature most strongly associated with gut feeling was a history of convulsions and the child’s overall appearance and breathing. The authors also found that gut feeling is strongly influenced by parental concern that the illness is different. Finally, less experienced clinicians reported it more frequently than their more senior counterparts. However, the diagnostic power of gut feeling was no better in experienced than non-experienced clinicians. The authors claim that gut feeling should make three things mandatory: conducting a full and careful examination; seeking advice from a more experienced clinician and providing the parent with safety netting advice. http://www.bmj.com/cgi/doi/10.1136/bmj.e6144 Should you ever go with your “gut feeling”? Can you define it? |
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Re: Should you ever go with your gut feeling?
posted at 27/9/2012 6:12 PM BST
on bmj.com
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Posts: 1012
First: 15/7/2011 Last: 15/6/2013 |
In any job sometimes your 'gut feeling' is pretty much right but you must think with your brain not your gut. That feeling or suspicion that you are on the right track is the spur to 'firm up' with objective data. |
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Re: Should you ever go with your gut feeling?
posted at 27/9/2012 7:36 PM BST
on bmj.com
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Posts: 11
First: 30/7/2012 Last: 7/1/2013 |
Your gut feeling could save a patients life. I wouldn't ignore it. OK, you might admit someone to hospital unnecessarily a few times in your career but so what? At the pointed part of the NHS, when a patient (adult or child) comes through my door it is sometimes glaringly obvious that they're going to hospital because they look so ill, it's just a matter of choosing which speciality. With children in particular though it would be a brave doctor who ignores that feeling of unease. |
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Re: Should you ever go with your gut feeling?
posted at 28/9/2012 5:09 PM BST
on bmj.com
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Posts: 7
First: 28/3/2012 Last: 14/3/2013 |
Hi, Not all information processing is conscious; intuition is often based on information we have attended to but at a subconscious level. Both conscious and subconscious information processing can be falliable to biases. It is recognised in both medicine and elsewhere such as management that intuitive feeling should be regarded in the decision making process because they are just as valid as conscious evidence that we are aware of attneding to. the biases during to subconscious/intuitive and conscious decision making can to some extent be reduced through training and education. |
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Re: Should you ever go with your gut feeling?
posted at 28/9/2012 5:23 PM BST
on bmj.com
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Posts: 1336
First: 13/4/2010 Last: 16/6/2013 |
Matthew - I don't call it "gut feeling" - I call it experience. The great advantage we have as GPs (which our hospital colleagues don't have) is that we often know our patients inside out and can tell when something is "not right". As far as children are concerned we are right to be over cautious - they are often less informative than adults, better at "compensating" when seriously ill and so on. However, what reassures me about this paper is that GPs diagnosing a child as non-serious infection are getting it right 99.8% of the time. Show me any other system that depends on human judgement that is less fallible than that. |
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Re: Should you ever go with your gut feeling?
posted at 28/9/2012 6:24 PM BST
on bmj.com
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Posts: 1302
First: 9/12/2011 Last: 12/6/2013 |
Matthew, In Police Work, it is known as Intuition, Many police Officers feel something when approaching a car late at night, a sick feeling in the Gut! Then you wlk up and there is the criminal you pulled over Holding a Pistol on his lap ready to kill you! I have had this happen many times in my Career, Lucklity I listened to my GUT FEELING, and I am still alive today,, Much to the Disdain of many I am sure! DuaneF |
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Re: Should you ever go with your gut feeling?
posted at 1/10/2012 9:06 AM BST
on bmj.com
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Posts: 64
First: 24/10/2011 Last: 11/6/2013 |
Yes, you should listen to your gut feeling. For an experienced doctor it is your braain telling you that something is wrong. Probably from a multitude of little clues that you have spotted, but have not registered at a conscious level. It has helped me frequently. |
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Re: Should you ever go with your gut feeling?
posted at 1/10/2012 7:27 PM BST
on bmj.com
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Posts: 324
First: 23/12/2011 Last: 3/5/2013 |
Hmm I think that this is something that should be used with caution. Too many times people can change 'using your gut feeling' to 'just doing what first comes to mind.' Both phrases are similar but have very different meanings. As we all know, expert opinon sits on the lowest rung of the evidence ladder so I think that 'using gut instinct' is all well and good but doctors need to keep a check on themselves to make sure this doesnt become just laziness... :D |
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Re: Should you ever go with your gut feeling?
posted at 3/10/2012 10:03 AM BST
on bmj.com
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Posts: 1213
First: 19/4/2010 Last: 14/6/2013 |
"Expert opinion sits on the lowest part of the evidence ladder" Hmmm. I would take an expert's opinion over a guideline every day of the week, and twice on Sundays. If all wee needed were guidelines, we could make doctors out of computers. Treating a patient is a study of n=1, and rarely to patients fit the entry requirements to studies (at least not in my practice), and you can't transfer population statistics to an individual patient. I do general medical ward rounds in the acute medical unit every two weeks. My job seems to be to pick out the one patient out of the 20 I see who is sick, and the juniors have not realised it. This is essentially a 'gut-ometer', or an 'experience-ometer'. So yes, I think definitely go with your gut - it's what makes you a doctor, and not a computer.
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Re: Should you ever go with your gut feeling?
posted at 3/10/2012 4:16 PM BST
on bmj.com
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Posts: 233
First: 15/5/2012 Last: 11/6/2013 |
In Response to Re: Should you ever go with your gut feeling?: Hmm I think that this is something that should be used with caution. Too many times people can change 'using your gut feeling' to 'just doing what first comes to mind.' Both phrases are similar but have very different meanings. As we all know, expert opinon sits on the lowest rung of the evidence ladder so I think that 'using gut instinct' is all well and good but doctors need to keep a check on themselves to make sure this doesnt become just laziness... :D Posted by NCantley Keep practising Medicine and in time your experiences will condition your vagus nerve and your brain- you will develop the gut feeling. In 20 years time, you too will become a Jedi, my young friend ( or shall I say "Paduwan"- a Jedi in training). |
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