title: Consensus on gut feelings in general practice.
abstract: BACKGROUND
  General practitioners sometimes base clinical decisions on gut feelings alone, even though there is little evidence of their diagnostic and prognostic value in daily practice. Research to validate the determinants and to assess the test properties of gut feelings requires precise and valid descriptions of gut feelings in general practice which can be used as a reliable measuring instrument.
  
  
  OBJECTIVE
  Can we obtain consensus on descriptions of two types of gut feelings: a sense of alarm and a sense of reassurance?
  
  
  METHODS
  Qualitative research including a Delphi consensus procedure with a heterogeneous sample of 27 Dutch and Belgian GPs or ex-GPs involved in academic educational or research programmes.
  
  
  RESULTS
  After four rounds, we found 70% or greater agreement on seven of the eleven proposed statements. A "sense of alarm" is defined as an uneasy feeling perceived by a GP as he/she is concerned about a possible adverse outcome, even though specific indications are lacking: There's something wrong here. This activates the diagnostic process by stimulating the GP to formulate and weigh up working hypotheses that might involve a serious outcome. A "sense of alarm" means that, if possible, the GP needs to initiate specific management to prevent serious health problems. A "sense of reassurance" is defined as a secure feeling perceived by a GP about the further management and course of a patient's problem, even though the doctor may not be certain about the diagnosis: Everything fits in.
  
  
  CONCLUSIONS
  The sense of alarm and the sense of reassurance are well-defined concepts. These descriptions enable us to operationalise the concept of gut feelings in further research.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of General Practice, Maastricht University, Maastricht, The Netherlands. praktijk@stolper.nl
authors.forename: Erik
authors.initials: E
authors.lastname: Stolper
authors.forename: Paul
authors.initials: P
authors.lastname: Van Royen
authors.forename: Margje
authors.initials: M
authors.lastname: Van de Wiel
authors.forename: Marloes
authors.initials: M
authors.lastname: Van Bokhoven
authors.forename: Paul
authors.initials: P
authors.lastname: Houben
authors.forename: Trudy
authors.initials: T
authors.lastname: Van der Weijden
authors.forename: Geert
authors.initials: G
authors.lastname: Jan Dinant
mesh_terms: D001291:Attitude of Health Personnel; D001530:Belgium; D002983:Clinical Competence; D003697:Delphi Technique; D003933:Diagnosis; D004644:Emotions; D005194:Family Practice / Q000592:standards*; D017144:Focus Groups; D006801:Humans; D009426:Netherlands; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011364:Professional Practice; D011379:Prognosis; D036301:Qualitative Research; D035501:Uncertainty