"Gut feelings" confirmed important in cancer diagnosis

A GP's diagnostic "gut feelings" have been demonstrated to be predictive of cancer in patients in a systematic review published by researchers from Oxford University.

Twelve articles and four online resources were included in the review published in the British Journal of General Practice. These described varied conceptualisations of gut feelings, which were often initially associated with patients being unwell rather than with a suspicion of cancer, and were commonly experienced in response to symptoms and non-verbal cues.

The study found that the "pooled odds of a cancer diagnosis" were four times higher when gut feelings were recorded and became even more predictive with increased clinical experience and familiarity with the patient.

The researchers also reported that, despite being included in some clinical guidelines, some GPs ignored or omitted gut feelings from referral letters as specialists might question the diagnostic value.

Dr Brian Nicholson, a GP and Clinical Lecturer in the Nuffield Department of Primary Care Health Sciences, University of Oxford, said: "The study highlights the art of General Practice - this gut feeling is something that GPs develop over several years as they build experience and have contact with patients. As well as the hard and fast symptoms of cancer, GPs can pick up a lot from the way a patient behaves.

"It could be that the patient is sitting uncomfortably, talking differently, or the way they get up out of their chair in the waiting room. They are all subtle cues that you pick up while seeing a patient which form part of a bigger picture that could lead to a cancer referral."

Dr Jonathan Leach, Honorary Secretary of the Royal College of GPs, commented: "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.

"It is also 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 we often use to help us make a diagnosis."