The Role of Gut Feeling as an Alarm Signal for Identifying Misdiagnoses in the Psychosomatic Consultation

Abstract

A psychosomatic consultation service offers an opportunity to correct misdiagnoses. The doctor's non-analytical, experience-based gut feeling plays an essential role as diagnostic trailblazer. In a case series study, the procedures of 165 psychosomatic consultations and the emotional and cognitive processes occurring in the consultant were recorded. The diagnostic process was analysed with reference to the dual process theory. With gut feeling, a distinction was made between a sense of alarm and a sense of reassurance. As an example, the processes that led to the discovery of misdiagnoses were presented at four consultations. A misdiagnosis was found in 24 consultations (16%). The reason for this was always a sense of alarm, which appeared in 29 of 165 consultations (18%). In 11 consultations (7%) there was a sense of reassurance, which in ten consultations was associated with a confirmation of the diagnosis and only in one case gave way to a sense of alarm and led to a later correction of the diagnosis. Paying attention to gut feeling and its sense of alarm is an effective method of recognizing misdiagnosis. Training programs should not only promote rational-analytical thinking, but also the doctor's self-critical introspection skills.