Understanding the role of GPs' gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence
Friedemann Smith C, Drew S, Ziebland S, et al. Br J Gen Pract. 2020;70(698):e612-e621.
SUMMARY: How helpful is a clinician’s gut feeling for diagnosing cancer in primary care?
Have you been seeing a patient and thought to yourself “something’s wrong here”? That’s clinical intuition, instinct, or gut feeling. But is this just vanity or paranoia?
Cancer, because it often presents non-specifically, may be particularly subject to our intuition.
These authors conducted a systematic review to assess whether cancer is more likely when a clinician has an intuitive sense that something is wrong.
They reviewed 6 databases and performed a quality appraisal on the articles they found.
12 studies, 4 prospective cohorts with 17,000+ patients. All studies were European.
Odds ratio (OR) = 4.24 for a cancer diagnosis when gut feeling was recorded (I2 = 87%).
OR = 5.43 if outlier study excluded (I2 = 0).
They didn’t calculate other test characteristics, but here they are:
EDITOR'S COMMENTARY - Steve Brown, MD Your gut feeling should probably not be ignored, but you definitely don’t want to follow it blindly. It could lead to wasteful follow-up testing and it’s not that helpful of a test. We don’t know how this applies in North America because there is a special interest in studying clinical intuition in Europe.
BOTTOM LINE: A clinician’s intuition or gut feeling that something is wrong increases the likelihood of a cancer diagnosis, but it is probably not useful enough as a test to be used reliably.