Diagnostic Accuracy and Determinants of GPs’ Gut Feelings regarding Dyspnea and/or Chest Pain complaints in General Practice: A Cross-Border Study

Huseyin Elbi, Ece Yokus, Merve Vatansever Balcan, Fatih Ozcan, Mithat Temizer, Marie Barais, Erik Stolper

Keywords: Dyspnea, chest pain, gut feelings, general practice,

Background:

Dyspnea and chest pain are common primary care complaints that range from benign to life-threatening conditions. General practitioners (GPs) are often the first caregivers in the health system, tasked with distinguishing between serious conditions and initiating appropriate referrals when necessary. However, diagnostic uncertainty frequently arises when specific clinical indicators are absent, particularly in the context of dyspnea and chest pain, where the underlying causes can be diverse and non-specific. In such situations, GPs often rely on gut feelings defined as a 'sense of alarm' and a 'sense of reassurance,' considered a third pathway in the cognitive process of diagnostic reasoning, medical decision-making, and problem-solving.

Research questions:

This study aims to investigate the diagnostic accuracy and determinants of GPs’ gut feelings when evaluating patients with dyspnea and/or chest pain. Building on the work of Barais et al., the research adopts a cross-border approach to exploring how gut feelings, precisely the ‘sense of alarm’ and ‘sense of reassurance,’ contribute to clinical decision-making.

Method:

This study will collect data from GPs in multiple European countries using the Gut Feelings Questionnaire after consultations with patients with dyspnea and/or chest pain. It will analyze determinants influencing gut feelings, such as patient characteristics and clinical context.

Results:

This study will demonstrate the predictive value of gut feelings in identifying serious outcomes related to dyspnea and/or chest pain in primary care. Determinants influencing gut feelings, such as patient characteristics and clinical context, are anticipated to provide insights into their role in diagnostic reasoning. These findings highlight the relevance of gut feelings in improving decision-making in primary care and informing the training of physicians, particularly in handling diagnostic uncertainty.

Conclusions:

This cross-border study will reveal the contribution of gut feelings to GPs’ clinical reasoning regarding dyspnea and chest pain. It aims to improve diagnostic quality and enhance patient safety in primary care.

Points for discussion:

How can the findings of this study be applied to improve diagnostic quality, patient safety, and the training of future general practitioners in managing diagnostic uncertainty?

How can GPs' patient recruitment and continuity be ensured throughout the study?

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