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Life & Times

Gut feeling is changing in the post-coronavirus world

Dipesh P Gopal and Sara Calderón-Larrañaga
British Journal of General Practice 2021; 71 (702): 24. DOI: https://doi.org/10.3399/bjgp21X714461
Dipesh P Gopal
GP and NIHR In-Practice Fellow at the Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry. Dipesh is interested in helping people who are living with and beyond cancer (cancer survivorship). Email: @dipeshgopal
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  • For correspondence: d.gopal@qmul.ac.uk
Sara Calderón-Larrañaga
GP and LISS-DTP Clinical Doctoral Research Fellow at the Centre for Primary Care and Mental Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry. Sara is investigating whether social prescribing can address the social determinants of type 2 diabetes in high-risk populations. @SaraCalderonL
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Research has shown gut feeling is important for GPs’ diagnosis of cancer in a primary care setting.1 Despite its importance, gut feeling assumes traditional consultation set-ups with streams of patients in crowded waiting rooms waiting to see a doctor every 10 minutes. Since the coronavirus pandemic the safest option for both patients and staff is seeing patients who do need to be seen in person with appropriate personal protective equipment (PPE). The changing role of gut feeling has implications for clinical, research, and educational primary care environments for the future.

GUT FEELINGS EXPERIENCED REMOTELY

Within general practice, telephone triage has existed for years but perhaps has been utilised at higher levels during the pandemic.2 Gut feeling is summed up as verbal and non-verbal cues in the context of GP knowledge and experience that could be categorised as unconscious type 1 or ‘fast’ processing. Face-to-face consultations are utilised when it is absolutely needed, and it may be difficult to judge facial cues behind masks. However, on the telephone we rely on verbal cues alone, on words, tone, and pitch used. Perhaps the research from gut feeling could be used when using video consultations, and perhaps introduce new elements into a consultation. A small minority of video consultations are hindered by technology. However, this modality gives a new aspect to a telephone consultation, that is, giving the ability to judge non-verbal cues safely. Despite this, it could be argued that video consultations and e-consultations reinforce the inverse care law in a two-tiered tech-literate and tech-illiterate society.3 We are particularly worried about the patients who no longer feel that it is safe to consult their family doctor. This can result in delayed presentations and potentially contribute to the excess mortality rates for non-coronavirus causes seen during the pandemic.4 When it comes to research, there is a change to how gut feeling manifests in clinical practice. There are established research centres both in the UK and Europe examining this topic in regards to face-to-face consultations and gut feeling, which will now have new areas of focus5 (https://www.gutfeelings.eu). These include understanding how gut feelings manifest on the telephone alone, facilitators and barriers during video consultations, as well as detection of non-verbal cues with face-mask wearing in face-to-face consultations. Perhaps a novel area for investigation would be the way that gut feeling can manifest using the nuance of language and expression on written e-consultations and their subsequent interpretation by a clinician.

Figure1

DETECTING SERIOUS DISEASE

Finally, gut feeling and detection of serious disease is mainly gained through experience, which is why our concern must turn towards future generations of doctors. Before the pandemic, GP trainees felt there was insufficient training for telephone consultations.6 While consultation modalities change, telephone consulting training should be fully integrated into in-hours GP rotations rather than be left to out-of-hours training. MRCGP curriculum and assessment changes must occur to assess other consultation modalities, such as audio consultation observation tools (COTs).7 It is only when sufficient competency and experience is reached in different consultation modalities that our trainees will be more able to detect serious disease using gut feeling.

As we move into a post-coronavirus world, general practice and medicine will no longer be the same, with great opportunity for positive change in health care. Gut feeling is changing in clinical practice, research, and education, hopefully without detriment to our patients.

Footnotes

  • This article was first posted on BJGP Life on 4 December 2020; https://bjgplife.com/gut

  • © British Journal of General Practice 2021

REFERENCES

  1. 1.↵
    1. Smith CF,
    2. Drew S,
    3. Ziebland S,
    4. Nicholson BD
    (2020) Understanding the role of GPs’ gut feelings in diagnosing cancer in primary care: a systematic review and meta-analysis of existing evidence. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp20X712301.
  2. 2.↵
    1. NHS Digital
    (2020) Appointments in general practice. https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice (accessed 10 Dec 2020).
  3. 3.↵
    1. Salisbury H
    (2019) Helen Salisbury: the inverse care law in the digital age. BMJ 364, l308, doi:10.1136/bmj.l308.
    OpenUrlFREE Full Text
  4. 4.↵
    1. Kraindler J,
    2. Barclay C,
    3. Tallack C
    (2020) Understanding changes to mortality during the pandemic: non-COVID-19 excess deaths in England and Wales (The Health Foundation).
  5. 5.↵
    1. Barnes RK,
    2. Salisbury C,
    3. Ridd M,
    4. Caddick B
    (2019) One in a Million: primary care consultations archive. http://www.bristol.ac.uk/primaryhealthcare/researchthemes/one-in-a-million (accessed 10 Dec 2020).
  6. 6.↵
    1. Chaudhry U,
    2. Ibison J,
    3. Harris T,
    4. et al.
    (2020) Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study. BJGP Open, DOI: https://doi.org/10.3399/bjgpopen20X101008.
  7. 7.↵
    1. Maru D,
    2. Gopal DP,
    3. Gandhi H
    (May 4, 2020) Here is how we prepare the next generations of GPs for remote consulting. BJGP Life, https://bjgplife.com/2020/05/04/here-is-how-we-prepare-the-next-generation-of-gps-for-remote-consulting (accessed 10 Dec 2020).
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British Journal of General Practice: 71 (702)
British Journal of General Practice
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January 2021
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Gut feeling is changing in the post-coronavirus world
Dipesh P Gopal, Sara Calderón-Larrañaga
British Journal of General Practice 2021; 71 (702): 24. DOI: 10.3399/bjgp21X714461

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Gut feeling is changing in the post-coronavirus world
Dipesh P Gopal, Sara Calderón-Larrañaga
British Journal of General Practice 2021; 71 (702): 24. DOI: 10.3399/bjgp21X714461
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  • Ambivalent sexism within medicine: reflections from four medical students
  • Books: long read: The Doctor Who Fooled The World. Andrew Wakefield’s War On Vaccines
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