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Abstract
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Researchers from the Netherlands have taken great interest in the role of intuitive knowledge in diagnostic reasoning during the last decade. They have especially discussed the concept of gut feeling, to which I will return later in this editorial. From a beginning of broadly defining the concept of intuition, their recent studies orient more towards different elements of intuition and the characteristics of its users. Several studies have shown that situations with high levels of complexity, uncertainty or emergency lead to increased use of intuition and experienced practitioners use intuition more than inexperienced colleagues do.1 Hospital specialists usually agree that hypotheses are based on intuition, but must be followed by analytical reasoning. General Practitioners (GPs) seem to use gut feelings more as a compass, steering them through uncertain and complex situations and busy office hours.2
Dr Erik Stolper and co‐workers have studied if there is a consensus about relying on gut feelings in general practice and found a high level of agreement on two types of gut feelings: a sense of alarm and a sense of reassurance. A "sense of alarm" is defined as an uneasy feeling perceived by a GP when concerned about a possible adverse outcome, even though specific indications are lacking. A sense of "reassurance" on the other hand is defined as a secure feeling about further management and course of a patient's problem, even if the physician may not be sure about the diagnosis.3 In this issue of Acta Paediatrica, Dr Stolper et al present a qualitative research paper concerning how Child Health Care (CHC) physicians struggle with gut feelings when managing suspicions of child abuse.4 In many respects, this work parallels that of an earlier paper concerning how GPs handle suspicion of child abuse.5 GPs in the Netherlands are family physicians, while CHC physicians follow up children's health and development at well baby clinics from zero to 4 years of age, a system similar to those in the Nordic countries. Both types of physicians generally under‐identify and under‐report child abuse, but the studies actually show that the low rate of reporting does not always reflect a low rate of detection. Severe cases are generally reported, but in many other instances the physicians try to improve the child's situation by making use of the trust the family has in their doctor, as well as by involving other professionals.
Suspicions of child maltreatment arise from common triggers such as bruises...
Language: en |