Modern medicine is led by evidence based guidelines and protocols. When a patient comes in, we are trained to take a thorough history, do an examination and compute this all using our knowledge of the latest evidence based practice to find a diagnosis. “You can’t go wrong if you simply follow the guidelines”, a senior surgeon once said to me when I was a medical student.

As scientists we are guided by research and that’s what keeps us accountable. However there have been many moments in my career as a GP where the guidelines and check-lists alone haven’t been enough. I had had times where I have collated all the information from my patient but when I have checked them off against the lists of signs and symptoms given to guide referrals to suspected cancer clinics, I have found it odd that my patient was deemed to be “fine.” I found it odd because every bit of me was saying “something is wrong” but I couldn’t explain why. I just had a gut feeling that made me want to investigate further and sadly I was right on each of these occasions.

We teach medical students about communication. Medicine is more than just pill prescribing. It’s an art. It is about recognising the needs of the person before you using a multitude of tools but most of all having an ability to be human with them. It is about listening – not just to the spoken word but also tapping into the silences. It is about connecting with the awkward pauses that often have a voice of their own, watching the subtleties of body language, about giving value to the sentiment of when a patient says, “I have a feeling...” or “I am worried it is..”

This goes beyond medicine though. I am sure you have had many times in life where something just didn’t feel right. You hear people when they know their partner has been unfaithful, when someone is lying, when you’re in trouble of get a gut feeling! We are born with this and we just don’t give it enough air time. We should tap into these feelings more because can potentially be a valuable asset.

I was really pleased this week to see some interesting research published in the British Journal of General Practitioners on this topic. This review, conducted in Oxford University, looked at 12 papers and 4 internet sources on the link between a GP’s gut feelings and cancer diagnosis. It found that the odds of a cancer diagnosis were 4 times higher when GPs recorded their gut feelings instead of solely following lists and protocols.

This goes beyond cancer diagnosis however. I have found cases where investigations have all been normal but a rare genetic condition has come to light that has been causing unusual symptoms for a patient. Often cases of abuse are found through an intuition that there is something more to the story. The beauty of general practice is that you do get to know your patients over a long period of time and therefore subtle changes can be picked up early on.

It got me thinking of the “new normal” that we are navigating through right now where, due to COVID, we are heading down a remote access model. Most consultations are taking place via telephone and video and whilst this is welcomed in part – we must move with the times – it must not take away the role of face to face consultations. It is during these face to face consultations that we can pick up the non-verbal cues and get a real time sense of what’s going on.

It is equally important that as a patient, you connect and communicate your gut feelings. We often forget that the greatest expert of your health is not a doctor, it is you. If you get a deep sense that something does not feel right over and over again, speak up about it. Don’t underestimate the power of the voice within.