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Gut instinct: a diagnostic tool?

Published online by Cambridge University Press:  19 March 2015

I Z Iqbal ,
N Kara  and
C Hartley
I Z Iqbal*
Affiliation:
Otolaryngology Department, Sunderland Royal Infirmary, UK
N Kara
Affiliation:
Otolaryngology Department, Sunderland Royal Infirmary, UK
C Hartley
Affiliation:
Otolaryngology Department, Sunderland Royal Infirmary, UK
*
Address for correspondence: Dr I Z Iqbal, Sunderland Royal Infirmary, Kayll Road, Sunderland SR4 7TP, UK E-mail: [email protected]
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Abstract

Objectives:

It is generally accepted that with experience clinicians develop the ability to identify patients who present with malignancy prior to a formal diagnosis. This ability cannot be quantified, nor is it a plausible substitute for investigation. This study aimed to evaluate the association between instinct and head and neck cancer diagnosis.

Methods:

A prospective study of patients requiring urgent diagnostic procedures for suspected cancer between August and December 2010 was performed. Risk factors, symptoms, signs and the clinician's impression were recorded. These were graded and subsequently correlated with histology findings.

Results:

Twenty-seven patients, with a mean age of 62.2 years, underwent a diagnostic procedure. Thirty per cent of patients were referred under the two-week pathway and 18.5 per cent had a previous history of head and neck cancer. A diagnosis of cancer was made in 37 per cent of patients. There was a positive correlation between clinical suspicion and cancer diagnosis (Kendall's tau-b = 0.648749).

Conclusion:

This study highlights the importance of clinical suspicion in cancer diagnosis. Although clinical suspicion cannot be quantified, it should be regarded as an integral part of patient assessment.

Keywords

HeadNeckNeoplasmsDiagnosisInvestigative Techniques
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 4 , April 2015 , pp. 365 - 368
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1National Institute for Health and Care Excellence. Guidance on Cancer Services. Improving Outcomes in Head and Neck Cancers: The Manual. In: http://www.nice.org.uk/guidance/csghn/evidence/improving-outcomes-in-head-and-neck-cancers-the-manual2 [17 September 2014]Google Scholar
2Rosen, MP, Sands, DZ, Morris, J, Drake, W, Davis, R. Does a physician's ability to accurately assess the likelihood of pulmonary embolism increase with training? Acad Med 2000;75:1199–205Google Scholar
3Buckingham, C, Adams, A. Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis. J Adv Nurs 2000;32:990–8Google Scholar
4Stolper, E, Van de Wiel, M, Van Royen, P, Van Bokhoven, M, Van der Weijden, T, Dinant, GJ. Gut feelings as a third track in general practitioners' diagnostic reasoning. J Gen Intern Med 2011;26:197–203Google Scholar
5Ferreira, MB, Garcia-Marques, L, Sherman, SJ, Sherman, JW. Automatic and controlled components of judgment and decision making. J Pers Soc Psychol 2006;91:797–813Google Scholar
6Evans, JSBT, Frankish, K. In Two Minds: Dual Processes and Beyond. Oxford: Oxford University Press, 2009Google Scholar
7Moreira, J, Bisoffi, Z, Narváez, A, Van den Ende, J. Bayesian clinical reasoning: does intuitive estimation of likelihood ratios on an ordinal scale outperform estimation of sensitivities and specificities? J Eval Clin Pract 2008;14:934–40Google Scholar
8Gill, CJ, Sabin, L, Schmid, CH. Why clinicians are natural Bayesians. BMJ 2005;330:1080–3Google Scholar
9Shimizu, T, Tokuda, Y. Real-world medical diagnosis: Intuitive process revisited. Int J Med Med Sci 2012;4:177–9Google Scholar
10Klein, G. The Power of Intuition: How to Use Your Gut Feelings to Make Better Decisions at Work. New York: Random House, 2004Google Scholar
11Hamm, RM. Clinical intuition and clinical analysis: expertise and the cognitive continuum. In: Dowie, J, Elstein, AS eds. Professional judgment. A reader in clinical decision making. Cambridge: Cambridge University Press, 1988;78–104Google Scholar
12Polanyi, M. The Tacit Dimension. London; Routledge and Kegan Paul, 1967Google Scholar
13Naqvi, N, Shiv, B, Bechara, A. The role of emotions in decision making: a cognitive neuroscience perspective. Curr Dir Psychol Sci 2006;15:260–4Google Scholar
14Baram, D, Bilfinger, T. Interaction of clinical suspicion and PET in the diagnosis of suspected thoracic malignancy. Med Sci Monit 2008;14:381–5Google Scholar
15Van den Bruel, A, Thompson, M, Buntinx, F, Mant, D. Clinicians' gut feeling about serious infections in children: observational study. BMJ 2012;345:1–9Google Scholar
16Mehanna, H, V Paleri, V, West, CML, Nutting, C. Head and neck cancer – Part 1: Epidemiology, presentation, and prevention. BMJ 2010;341:c4684Google Scholar