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GPs' gut feelings more predictive than check lists, researchers say

A GP’s suspicion of serious disease is more strongly predictive than many of the symptoms and signs conventionally used in schemes such as the two-week rule for urgent suspected cancer referrals, research has concluded.

A study conducted in Denmark, involving over 400 GPs and 16,000 patient contacts, concluded that the two-week wait system used in the UK and Denmark may actually prevent early diagnosis because they are based on symptom check lists, and do not include GPs’ ‘gut feelings’ about serious problems.

The report, published in the British Journal of General Practice, has recommended that referral pathways are reformed so that patients suspected by their GP to suffer from serious condition get rapid, direct access to investigations such as imaging and endoscopy.

The research group, led by Professor Peter Vedsted, demonstrated a positive predictive value for diagnosis of cancer or serious disease of almost 10% in the two months following consultation.

The report concluded: ‘The present study confirms that action should be taken when the GP suspects serious disease; PPVs are relatively high, and the healthcare system should support this investigation by providing access to, for example, imaging and endoscopies. The UK and Denmark have organised cancer investigation as a fast-track system (for example, two-week wait referrals) that requires patients to present with specific alarm symptoms to qualify for immediate referral.’

‘However, as many patients in general practice present with vague or unspecific symptoms, GP access to relevant and speedy diagnostic investigations is crucial. Organisation of the primary diagnostic pathways and how to support GPs should be a main focus in future studies in this area.’

Readers' comments (11)

  • My gut feeling is the NHS is terminal and has a poor prognosis.

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  • To the GP above, I my be naive but please do not give up yet. We know we have the best and fairest health care system in the world that just needs the chance to adapt to some modern issues and constraints- from the bottom up rather than the top down. Lets be clear about what it is we value then mobilise our patients to fight for it. We are in an election year and the survival of the NHS is potentially the issue that unites the population more than any other. I am seeing my patients take to the streets over this in a way I never thought possible. People are starting to become aware and listen. We have friends out there and we need to wake them up. I never thought I would have the energy but I am finding it in the response of my patients and colleagues. Get the posters (BMA/ RCGP campaigns) start talking to patients and let them know they have the power to change things. This is our last chance.. Naomi Beer. Jubilee St Practice.

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  • "Gut feeling"( ie experience) is better than tick box medicine. What a surprise! !!

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  • Took Early Retirement

    GPs better than check lists- golly! Does the Pope tish in the woods?

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  • Obviously we all knew this already, but speedy access to diagnostics is not affordable, hence the powers to be find it easier to say GPs diagnose late...bla bla. Could not agree more with the first comment.

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  • It's official! We actually know what the hell we are doing!!!!

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  • And the more experienced you are the better....except that all the experienced GPs have over experienced the NHS and want to retire.

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  • I agree the experienced gps are leaving - as am Iafter 21years

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  • This is one of the issues that made me leave after 26 years. As a GP trainer I just could not continue to "train" people to believe in the protocols to the exclusion of reason and found that they were no longer trained to think, but just look up which "pathway" to use.

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  • Gut feeling helps when a GP has good medical experience in a broad range of medical specialities under his belt, but I dont feel it helps with the current cohort of newly trained GPs who have just 3 years training - I would expect them to follow protocols, guidelines and not their gut feelings.

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