Smith Claire Friedemann, Kristensen Benedikte Møller, Andersen Rikke Sand, Hobbs Fd Richard, Ziebland Sue, Nicholson Brian D
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Research Unit for General Practice, Department of Public Health, Aarhus University and University of Copenhagen, Denmark.
Br J Gen Pract. 2021 Apr 29;71(706):e356-e363. doi: 10.3399/bjgp21X714269. Print 2021 May.
The use of gut feelings to guide clinical decision making in primary care has been frequently described but is not considered a legitimate reason for cancer referral.
To explore the role that gut feeling plays in clinical decision making in primary care.
Qualitative interview study with 19 GPs in Oxfordshire, UK.
GPs who had referred patients to a cancer pathway based on a gut feeling as a referral criterion were invited to participate. Interviews were conducted between November 2019 and January 2020, and transcripts were analysed using the one sheet of paper method.
Gut feeling was seen as an essential part of decision making that facilitated appropriate and timely care. GPs distanced their gut feelings from descriptions that could be seen as unscientific, describing successful use as reliant on experience and clinical knowledge. This was especially true for patients who fell within a 'grey area' where clinical guidelines did not match the GP's assessment of cancer risk, either because the guidance inadequately represented or did not include the patient's presentation. GPs sought to legitimise their gut feelings by gathering objective clinical evidence, careful examination of referral procedures, and consultation with colleagues.
GPs described their gut feelings as important to decision making in primary care and a necessary addition to clinical guidance. The steps taken to legitimise their gut feelings matched that expected in good clinical practice.
在基层医疗中，利用直觉来指导临床决策的情况屡有描述，但它并不被视为癌症转诊的合理理由。
探讨直觉在基层医疗临床决策中所起的作用。
对英国牛津郡的19名全科医生进行定性访谈研究。
邀请那些曾基于直觉作为转诊标准将患者转诊至癌症诊疗路径的全科医生参与。访谈于2019年11月至2020年1月期间进行，访谈记录采用单页纸法进行分析。
直觉被视为决策的重要组成部分，有助于提供恰当且及时的医疗服务。全科医生将他们的直觉与那些可能被视为不科学的描述区分开来，称成功运用直觉依赖于经验和临床知识。对于那些处于“灰色地带”的患者而言尤其如此，即临床指南与全科医生对癌症风险的评估不匹配，原因要么是指南对患者症状的表述不充分，要么是未涵盖患者的症状表现。全科医生试图通过收集客观临床证据、仔细审查转诊程序以及与同事协商来使他们的直觉合理化。
全科医生称他们的直觉对基层医疗决策很重要，是临床指南的必要补充。他们为使直觉合理化所采取的步骤符合良好临床实践的预期。
