Abstract
BackgroundGeneral practitioners sometimes base clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice. Research to validate the determinants and to assess the test properties of gut feelings requires precise and valid descriptions of gut feelings in general practice which can be used as a reliable measuring instrument. Research question: Can we obtain consensus on descriptions of two types of gut feelings: a sense of alarm and a sense of reassurance?MethodsQualitative research including a Delphi consensus procedure with a heterogeneous sample of 27 Dutch and Belgian GPs or ex-GPs involved in academic educational or research programmes.ResultsAfter four rounds, we found 70% or greater agreement on seven of the eleven proposed statements. A "sense of alarm" is defined as an uneasy feeling perceived by a GP as he/she is concerned about a possible adverse outcome, even though specific indications are lacking: There's something wrong here. This activates the diagnostic process by stimulating the GP to formulate and weigh up working hypotheses that might involve a serious outcome. A "sense of alarm" means that, if possible, the GP needs to initiate specific management to prevent serious health problems. A "sense of reassurance" is defined as a secure feeling perceived by a GP about the further management and course of a patient's problem, even though the doctor may not be certain about the diagnosis: Everything fits in.ConclusionThe sense of alarm and the sense of reassurance are well-defined concepts. These descriptions enable us to operationalise the concept of gut feelings in further research.
Highlights
General practitioners sometimes base clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice
Three elements are important in defining a sense of alarm: the feeling that there seems to be something wrong without the doctor having objective arguments, a distrust of the situation because of uncertainty about the prognosis of the complaints, and the need for some kind of intervention to prevent serious health problems
When GPs experience a sense of reassurance, they are sure about the prognosis and therapy, even in the absence of a diagnosis
Summary
Four rounds were needed to reach consensus. During the entire process, eleven statements were presented to the participants, the six original ones and five new ones that emerged from the comments. Uncertainty emerged as a key word from the focus groups, it was difficult to keep it in, due to disagreement about the first statement presented to the Delphi panel. In this statement we had tried to unify the two types of gut feeling in one phrase about the degree of uncertainty. The significance of uncertainty as a central element in the concept of gut feelings had resulted from our previous research, it seemed too theoretical to be used to summarise the two types of gut feeling in one statement in the first round. In the second round we added another statement (9) about the process of gut feelings, based on the comments of the participants. It was not difficult to distinguish between accepted and rejected statements
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