Should doctors’ ‘gut feelings’ play a role in medicine?

A new study suggests that a physician’s gut feelings -- a sense that something is wrong even when everything checks out in the standard clinical exam -- may contain more information than he or she gives them credit for.

A growing literature has begun to ask whether such gut feelings add anything substantive to a doctor’s clinical exam. But in general the studies have been limited by a shaky understanding of just what is meant by gut feeling -- specifically, which aspects of a patient visit lead to a doctor’s gut feeling that are not part of the standard clinical exam.

The authors of the new study, published this week in the British Medical Journal, focused on two questions: What exactly is a doctor’s gut feeling? And can it help physicians identify patients who are sicker than they appear?

To do this, researchers followed 3,890 children under age 16 who showed up in doctors’ offices in the Flanders region of Belgium. The children were generically complaining of feeling sick. The researchers wanted to know how many of those children would come down with serious infections like pneumonia, sepsis or meningitis and, of those that did, how many were referred straight to a hospital.

More important, they wanted to know whether a doctor intuited the onset of a serious infection even if the clinical examination did not suggest one was present.

Fortunately for the kids (but unfortunately for the researchers), only 21 of the children came down with serious infections that landed them in a hospital. Of those 21, six had a clinical exam that did not lead the doctor to believe they had a serious illness.

In two of those six cases, however, the physician did have a gut feeling that something was seriously wrong. More generally, physicians had gut feelings that something was wrong in 15 of the 21 cases of serious infection.

So what components led physicians to their gut feelings? Although the term is purposefully vague, the researchers were able to correlate some aspects of the patients with the gut feeling. Topping the list, unsurprisingly, was a history of convulsions, along with other physical traits like the patient’s pattern of breathing, and any significant weight loss.

But also on the list as a significant contributor was the opinion of the parent. Parents who expressed concern that the illness was somehow unlike past illnesses significantly increased the likelihood that a physician would have a gut feeling that something was seriously wrong.

So, do the numbers support using a doctor’s gut feeling to determine whether to admit a sick child to a hospital? The authors of the study contend that doing so would have caught two of the six cases of serious infection that were originally missed -- at a cost of about 44 false alarms. Though such false alarms come with costs, including unnecessary hospitalizations and the expenses that come with them, the researchers say this trade-off is worth it.

In the end, the authors acknowledge, this study may have observed too few cases of serious infection to say anything definitive about the value of gut feeling in preventing and treating serious infection. But they do believe there are substantive lessons physicians, and families, can learn from it.

Most important, the researchers say, physicians should pay more attention to the things, like the family’s opinion, that contribute to their gut feeling. Trusting your gut, they point out, is not some mystical process, but rather most likely represents the recognition of traits and symptoms that are not explicitly tested for.

If physicians can begin to consciously include those features in their normal exam, they write, the need to trust their gut to catch such cases will diminish.

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