Doctors' gut feeling should not be ignored

Doctors shouldn't ignore a 'gut feeling' about a serious illness when treating a child that comes into their surgery, suggests a study by researchers from the University of Oxford and Katholieke Universiteit Leuven in Belgium.

'Gut feeling is an additional tool for GPs that takes more into account than just the purely clinical presentation,' explains Dr Ann Van den Bruel, who led the research at the Department of Primary Care Health Sciences at the University of Oxford. 'It is important that gut feeling is recognised as such and considered a valid argument for taking action.

'We feel that experiencing a gut feeling about a child should make a GP consider 3 things: carry out a full and very careful examination looking for possible warning signs or red flags; ask the opinion of someone with more experience; or provide clear and specific advice to parents on how and when to come back.'

Serious infection can easily be missed in young children. Dr Van den Bruel says spotting those few serious infections over the many minor coughs and colds doctors see is a difficult task.

'It can be very difficult when children have only been sick for a very short time, because the body has not yet developed the specific signs and symptoms that could make you suspect a serious infection,' she says. 'And because serious infections are now increasingly rare thanks to immunisation policies, doctors have less experience with serious infections than they used to.'

However, a clinician's intuitive feeling that something is wrong, even after examination that suggests otherwise, appears to have diagnostic value.

The researchers from Oxford and Belgium carried out an observational study on 3890 children under 16 years old who presented in primary care in Flanders, Belgium in 2004.

They wanted to see what added value gut feeling provides to a diagnosis, and recorded factors that included the doctor’s overall impression and whether gut feeling suggested something more serious was wrong.

Out of the 3369 children assessed as having a non-severe illness at the time of consultation, 6 (0.2%) were later admitted to hospital with a serious infection. Results show that acting on gut feeling had the potential to prevent 2 of the 6 cases being missed at the cost of 44 false alarms, but that these were not unmanageable.

When the doctor didn’t have that gut feeling that something was wrong, the child was less likely to have a serious illness. The researchers found that in the absence of a gut feeling, the probability that the child did in fact end up with a serious infection decreased from 0.2% to 0.1%.

Less experienced clinicians reported a gut feeling more frequently than their more senior counterparts. However, the diagnostic power of gut feeling was no better in experienced than non-experienced clinicians.