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Cultivating Doctors’ Gut Feeling: Experience, Temporality and Politics of Gut Feelings in Family Medicine

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Abstract

For the past decade, within family medicine there has been a focus on cultivating doctors gut feelings as ‘a way of knowing’ in cancer diagnostics. In this paper, building on interviews with family doctors in Oxford shire, UK we explore the embodied and temporal dimensions of clinical reasoning and how the cultivation of doctors’ gut feelings is related to hierarchies of medical knowledge, professional training, and doctors’ fears of litigation. Also, we suggest that the introduction of gut feeling in clinical practice is an attempt to develop a theory of clinical reasoning that fits the biopolitics of our contemporary. The turn towards predictive medicine and the values introduced by accelerated diagnostic regimes, we conclude, introduce a need for situated and embodied modes of reading bodies. We contribute theoretically by framing our analysis within a sensorial anthropology approach.

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Notes

  1. ‘The positive predictive value of symptoms’ is a technical term which refers to the risk that an individual have a cancer when presenting with a given symptom/sensorial experience. As discussed by Andersen elsewhere it is, however, a highly unstable phenomenon (see Andersen 2017).

  2. The letter x serves to anonymize the authors of the paper. Later the authors will insert their proper names..

References

  • Andersen, Rikke Sand 2017 Directing the Senses in the Contemporary Orientations to Cancer Disease Control: Debating Symptom Research. Tidsskrift for Forskning i Sygdom og Samfund, 14(26).

  • Armstrong David (1985) Space and time in British general practice. Social Science and Medicine, 20(7):659–666. https://doi.org/10.1016/0277-9536(85)90054-1.

    Article  Google Scholar 

  • Aronowitz, Robert A. (2007) Unnatural History: Breast Cancer and American Society. Cambridge: Cambridge University Press.

    Google Scholar 

  • Csordas, Thomas (1993). Somatic Modes of Attention. Cultural Anthropology, 8(2):135–156.

    Article  Google Scholar 

  • Donker, Gé A., E. Wiersma, L. van der Hoek, and M. Heins (2016) Determinants of general practitioner’s cancer-related gut feelings—a prospective cohort study. BMJ Open 6(9):e012511. https://doi.org/10.1136/bmjopen-2016-012511.

    Article  Google Scholar 

  • Dreyfus Hubert L., and Stuart. E. Dreyfus (1986) Mind Over Machine The Power of Human Intuitive Expertise in the Era of the Computer.New York: Free Press.

    Google Scholar 

  • Foucault, Michel (1997) The Birth of the Clinic: An Archaeology of Medical Perception. London: Routledge.

    Google Scholar 

  • Friedemann Smith, Claire, S. Drew, Sue Ziebland, and Brian D. Nicholson (2020). Understanding the role of general practitioners’ gut feelings in diagnosing cancer in primary care: A systematic review and meta-analysis of existing evidence. British Journal of General Practice 70(698):612–621. https://doi.org/10.3399/bjgp20X712301

    Article  Google Scholar 

  • Fugelli, Per (1998). Clinical practice: between Aristotle and Cochrane. Schweizerische Medizinische Wochenschrift 128(6):184–188.

    Google Scholar 

  • Geurts, Kathryn (2003). Culture and the Senses: Bodily Ways of Knowing in an African Community. 1st ed. Vol. 3. Berkerley: University of California Press.

    Book  Google Scholar 

  • Hammer, Gili (2017). You can learn merely by listening to the way the patient walks through the door: The transmission of sensory medical knowledge. Medical Anthropology Quarterly 32(1):138–154

    Article  Google Scholar 

  • Hamilton, William, Robert Lancashire, Debbie Sharp, Tim J. Peters, Kk Cheng, and Tom Marshall, (2009) The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study. BMC Medicine 7(1):17. https://doi.org/10.1186/1741-7015-7-17

    Article  Google Scholar 

  • Holtedahl, Knut (2014) Predictive Values of GPs’ Suspicion of Serious Disease Are High Enough to Warrant Subsequent Investigation. Evidence-Based Medicine 19(6):232–232

    Article  Google Scholar 

  • Howes, David (2005). Introduction In: Howes, David (ed.). Empire of the Senses. 1. edn. Oxford: Berg Publishers.

    Google Scholar 

  • Howes, David and Classen, Constance (2014). Ways of Sensing: Understanding the Senses In Society. London: Routledge.

    Google Scholar 

  • Ingeman, Mads L., Morten B. Christensen, Flemming Bro, Søren T. Knudsen, and Peter Vedsted, (2015). The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer–a cross-sectional study of patient characteristics and cancer probability. BMC Cancer 15(1):421. https://doi.org/10.1186/s12885-015-1424-5.

    Article  Google Scholar 

  • Ingold, Tim. (2018) Anthropology: Why it matters. Cambridge: Polity Press.

    Google Scholar 

  • Jensen, Henry, Marie Louise Tørring, Frede Olesen, Jens Overgaard, and Peter Vedsted, (2014) Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study. BMC Cancer 14(1):636. https://doi.org/10.1186/1471-2407-14-636.

    Article  Google Scholar 

  • Kaufman, Sharon R. (2015). \Ordinary Medicine: Extraordinary Treatments, Longer Lives, and Where to Draw the Line. Durham: Duke University Press.

    Book  Google Scholar 

  • Kohn, Eduardo (2013) How forests think: Toward an anthropology beyond the human. Berkeley: University of California Press.

    Book  Google Scholar 

  • Lock, Margaret (2013) The Alzheimer Conundrum: Entanglements of Dementia and Aging. Princeton, N.J.: Princeton University Press.

    Book  Google Scholar 

  • Mattingly, Cheryl, and Maureen H. Fleming, (1994) Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice. Philadelphia: FA Davis.

    Google Scholar 

  • Mishler, Elliot (2005). Patient stories, narratives of resistance and the ethics of humane care: a la recherche du temps perdu. Health 9(4):431–451. https://doi.org/10.1177/1363459305056412

    Article  Google Scholar 

  • Mongtomery, Kathryn (2005) How doctors think: Clinical judgment and the practice of medicine. Oxford: Oxford University Press.

    Google Scholar 

  • Nicholson, Brian. D., Jason Oke, Claire Friedemann Smith, Julie-Ann Phillips, Jennifer Lee, Lucy Abel, Sadie Kelly, Isabella Gould, Toni Mackay, Zoe Kaveney, and Suzie Anthony (2018) The Suspected CANcer (SCAN) pathway: protocol for evaluating a new standard of care for patients with non-specific symptoms of cancer. BMJ Open 8(1):e018168. https://doi.org/10.1136/bmjopen-2017-018168

    Article  Google Scholar 

  • Nicholson Brian D., Willie Hamilton, Constantinos Koshiaris, Jason Oke, F. D. Richard Hobbs, and Paul Aveyard (2020) The association between unexpected weight loss and cancer diagnosis in patients attending primary care: a matched cohort analysis using routinely collected electronic health record data. British Journal of Cancer. https://doi.org/10.1038/s41416-020-0829-3

    Article  Google Scholar 

  • Polanyi, Michael (1966) The Tacit Dimension. Garden City, New York: Doubleday & Company.

    Google Scholar 

  • Rubin, Greg, Anette Berendsen, S. Michael Crawford, Rachel Dommett, Craig Earle, Jon Emery, Tom Fahey, Lugi Grassi, Eva Grunfeld, Sumit Gupta, and Willie Hamilton (2015). The expanding role of primary care in cancer control. The Lancet Oncology 16(12):123

    Article  Google Scholar 

  • Rudebeck, Carl E (2019) Relationship based care—how general practice developed and why it is undermined within contemporary healthcare systems, Scandinavian Journal of Primary Health Care 37(3):335–344, DOI: https://doi.org/10.1080/02813432.2019.16399091-1272.

    Article  Google Scholar 

  • Stolper, Erik, Paul Van Royen, Margje Van de Wiel, Marloes Van Bokhoven, Paul Houben, Van der Weijden, Trudy, and Geert J. Dinant (2009) Consensus on gut feelings in general practice. BMC Family Practice 10(1):66. https://doi.org/10.1186/1471-2296-10-66.

    Article  Google Scholar 

  • Stolper, Erik (2010) Gut feelings in general practice. Datawyse: Universitaire Pers Maastricht.

    Book  Google Scholar 

  • Stolper, Erik, Margje Van de Wiel, Paul Van Royen, Marloes Van Bokhoven, Trudy Van der Weijden, and Geert J. Dinant (2011) Gut feelings as a third track in general practitioners’ diagnostic reasoning. Journal of General Internal Medicine 26(2):197–203. https://doi.org/10.1007/s11606-010-1524-5.

    Article  Google Scholar 

  • Ziebland, Sue, Birgit Rasmussen, John MacArtney, Senada Hajdarevic, and Rikke Sand Andersen (2019) How wide is the Goldilocks Zone in your health system?. Journal of Health Services Research Policy 24(1):52–56.

    Article  Google Scholar 

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Acknowledgement

The authors confirm that the work described in this paper is original primary research conducted by the authors and has not been taken from the work of others, save and to the extent that such work has been cited and acknowledged in the text. It has not been published nor is it under consideration anywhere else.

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Authors and Affiliations

  1. Region Zealand, Primary Health Care, Alléen 15, 4180, Sorø, Denmark

    Benedikte Møller Kristensen & Claire Friedemann Smith

  2. Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins allé 2, 8000, Århus, Denmark

    Benedikte Møller Kristensen

  3. Department of Public Health, Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark

    Benedikte Møller Kristensen

  4. Department of Public Health, Research Unit for General Practice, Southern University, JB. Winsløws vej 9B, 5000, Odense S, Denmark

    Rikke Sand Andersen

  5. Department of Anthropology, Aarhus University, Moesgaard Alle 15, 8270, Højbjerg, Denmark

    Rikke Sand Andersen

  6. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK

    Brian David Nicholson & Sue Ziebland

Authors
  1. Benedikte Møller Kristensen
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  2. Rikke Sand Andersen
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  3. Brian David Nicholson
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  4. Sue Ziebland
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  5. Claire Friedemann Smith
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Correspondence to Rikke Sand Andersen.

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Conflict of interest

In the past the authors have been supported by or received grants from CRUK, NIHR, Macmillan, NHS England and The Danish Cancer Society. The authors declare no other activities that could appear to have influenced the submitted work.

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Kristensen, B.M., Andersen, R.S., Nicholson, B.D. et al. Cultivating Doctors’ Gut Feeling: Experience, Temporality and Politics of Gut Feelings in Family Medicine. Cult Med Psychiatry 46, 564–581 (2022). https://doi.org/10.1007/s11013-021-09736-3

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  • DOI: https://doi.org/10.1007/s11013-021-09736-3

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