Abstract 6: The Role of GPs’ Gut Feelings in Diagnosing Cancer in Primary Care

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.
• Results:
• 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:
• Sensitivity 44%
• Specificity 83%
• Positive likelihood ratio = 2.6
• Negative likelihood ratio = 0.67

PMID: 32839162

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.