‘Don’t discount doctor’s gut feeling’

Don’t discount a doctor’s gut feeling when it comes to serious illness, especially those affecting children, a new study suggests.

A clinician’s intuitive feeling that something is wrong, even after examination that suggests otherwise, seems to have even greater diagnostic value than most symptoms and signs.

Serious infection can easily be missed in young children and making a diagnosis has been described as “like finding a needle in a haystack.”

Studies have suggested it should be seen as highly important in its own right but there is lack of understanding about whether it can be seen as useful, British Medical Journal reported.

The gut feeling hinges on a doctors ‘sense of reassurance or alarm,’ bearing on their degree of certainty about the prognosis (future outcome) of the disease. Alarm implies that he perceives an uneasy feeling about a possible adverse outcome, according to an Antwerp statement.

The team of researchers which also included Paul Van Royen, University of Antwerp, Belgium, therefore carried out an observational study on 3,890 children aged between 0 and 16 years who reported for primary care in Flanders, Belgium in 2004.

Out of the 3,369 children assessed as having a non-severe illness at the time of consultation, six were later hospitalised 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.”

In fact, 21 out of the 3,890 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.