Physicians' Gut Feelings Should Not Be Dismissed
(HealthDay News) – Having a gut feeling about the seriousness of an illness, despite clinical assessment of non-severe illness, is associated with an increased risk of serious illness, according to a study published online Sept 25 in BMJ.
Ann Van den Bruel, MD, PhD, from the Radcliff Observatory Quarter in Oxford, U.K., and colleagues conducted an observational study involving a consecutive series of 3,890 children and young people aged 0–16 years in primary care to investigate the basis and added value of clinicians' "gut feeling" that infections are more serious than they appear based on clinical assessment.
A total of six of the 3,369 children and young people assessed clinically as having a non-severe illness were subsequently admitted to hospital with a serious infection. The researchers found that intuition that something was wrong correlated with a significant increase in the risk of serious illness (likelihood ratio, 25.5). Potentially, two of the six cases could have been prevented by acting on this gut feeling, at a cost of 44 false alarms. Features that correlated most strongly with gut feeling included the child's overall response, abnormal breathing, weight loss, and convulsions. Parental concern that the illness was different from their previous experience was the strongest contextual factor.
"Gut feelings should not be ignored but used in decision making," the authors write. "Having a gut feeling that something is wrong should make three things mandatory: the carrying out of a full and careful examination, seeking advice from more experienced clinicians (by referral if necessary), and providing the parent with carefully worded advice to act as a 'safety net.'"