Clinical management
Trust your gut feelings when you suspect someone could have a more serious illness
Gut feelings come from clinical experience, empathy with patients and attention to detail. They can play a crucial role in decision making, for instance when assessing cancer risk, prompting GPs to engage in deeper clinical reasoning and investigation. GPs can however be wary of relying on gut feelings as a justification to not investigate a patient further.
WiseGP actions:
Record in a patients’ notes when your decision has been influenced by a gut feeling and consider a teaching session with your GP registrar about gut feelings, discussing case examples.
Read more about the research informing these recommendations here:
https://bjgp.org/content/71/706/e356
Remembering a “normal” test result doesn’t always rule out disease
Between 1/5 to 1/10 patients who have cancer will have a negative test (CXR/ CA-125/ FIT test). Cancer risk rises with age, whilst a borderline result indicates a greater cancer risk than a very low test value. Tests should consequently never be a substitute for the skilled interpretation of clinical information and the application of clinical judgement, aided by gut feelings. Cancer risk rises with age and a borderline raised result indicates a greater cancer risk than a very low test value. Uncertainty can always be shared with patients.
WiseGP actions:
Perform a significant event analysis where there has been a potential cancer diagnosis delay.
Use gut feelings alongside clinical judgement when interpreting negative test results and share uncertainty with patients and colleagues.
Consider use of a vague symptoms referral pathway if available in your area for referral of cases where investigations have been normal but clinical suspicion of cancer remains.
Read more about the research informing these recommendations here:
