• Erik Stolper, Margje Van de Wiel, Van RoyenPaulP, Marloes Van Bokhoven, Trudy Van der Weijden, and Geert Jan Dinant.
• Faculty of Health, Medicine and Life Sciences, Caphri School for Public Health and Primary Care, Department of General Practice, Maastricht University, PO Box 616 6200 MD, Maastricht, The Netherlands. cf.stolper@hag.unimaas.nl
• J Gen Intern Med. 2011 Feb 1; 26 (2): 197203197-203.

BackgroundGeneral practitioners (GPs) are often faced with complicated, vague problems in situations of uncertainty that they have to solve at short notice. In such situations, gut feelings seem to play a substantial role in their diagnostic process. Qualitative research distinguished a sense of alarm and a sense of reassurance. However, not every GP trusted their gut feelings, since a scientific explanation is lacking.ObjectiveThis paper explains how gut feelings arise and function in GPs' diagnostic reasoning.ApproachThe paper reviews literature from medical, psychological and neuroscientific perspectives.ConclusionsGut feelings in general practice are based on the interaction between patient information and a GP's knowledge and experience. This is visualized in a knowledge-based model of GPs' diagnostic reasoning emphasizing that this complex task combines analytical and non-analytical cognitive processes. The model integrates the two well-known diagnostic reasoning tracks of medical decision-making and medical problem-solving, and adds gut feelings as a third track. Analytical and non-analytical diagnostic reasoning interacts continuously, and GPs use elements of all three tracks, depending on the task and the situation. In this dual process theory, gut feelings emerge as a consequence of non-analytical processing of the available information and knowledge, either reassuring GPs or alerting them that something is wrong and action is required. The role of affect as a heuristic within the physician's knowledge network explains how gut feelings may help GPs to navigate in a mostly efficient way in the often complex and uncertain diagnostic situations of general practice. Emotion research and neuroscientific data support the unmistakable role of affect in the process of making decisions and explain the bodily sensation of gut feelings.The implications for health care practice and medical education are discussed.

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