GPs are more like to make a cancer diagnosis when they have a 'gut feeling' even when patients don’t meet the official criteria for referral to specialist care, according to new research.
A systematic review published in the British Journal of General Practice examined the current evidence regarding GPs’ gut feelings for cancer and collated the factors that are thought to prompt a feeling of suspicion or instinct.
It found that gut feelings in this context were multiple verbal and non-verbal patient cues in the context of the GPs’ clinical knowledge and experience.
Gut feelings were conceptualised as an uneasy feeling, typically triggered by a rapid summing up of multiple verbal and non-verbal cues and were considered complementary to evidence-based practice, being included in some clinical guidelines and as entry criteria to cancer investigation.
The authors concluded that triggers of gut feelings not included in referral guidance deserve further investigation as predictors of cancer. Non-verbal cues that trigger gut feelings appear to be reliant on continuity of care and clinical experience; they tend to remain poorly recorded and are, therefore, inaccessible to researchers.
Remote consultations lack the non-verbal cues used to make a diagnosis
Dr Jonathan Leach, Honorary Secretary of the Royal College of GPs, said: “GPs consider a huge variety of factors when making a patient diagnosis. As well as more obvious physical symptoms, non-verbal cues can often indicate that something is wrong – not necessarily what the patient has made an appointment to speak about. This ‘gut feeling’ or intuition is something that GPs develop by having close, trusting relationships with patients that are often built over time, and isn’t something that should be ignored.
“As this paper suggests, a GP’s ‘gut feeling’ can be useful in identifying potential serious health conditions, such as cancer, even when patients don’t meet the official criteria for referral to specialist care. This is one reason why GPs need some flexibility in being able to refer patients where they are concerned as well as better access to investigations in the community, and the appropriate training to use them, so they can pursue their intuition, and take the results into account when making an informed decision to refer a patient.
The RCGP said this was something that should be considered when looking into the way patients access general practice services in the future. Remote consultations can be convenient for patients, and they have been vital in helping to stop the spread of the Covid-19 virus and keeping patients safe during the pandemic. However, they can pose challenges for GPs, not least the lack of non-verbal cues that they often use to make a diagnosis."
Dr Leach added: "Whilst there is a place for remote consulting in general practice, neither GPs nor patients want to see it become a totally remote service, but one where patients can choose how to access general practice according to their needs and preferences.
“Timely diagnosis of cancer can be essential in achieving positive health outcomes for patients and the RCGP has developed resources to support GPs and our teams in this area. It is now important that this research is taken into account as guidelines and criteria for referral for suspected cancers are developed and updated.”