Gut Instinct: A Diagnostic Tool?

Abstract

Objective: It is generally accepted that with experience, clinicians develop an ability to identify patients who present with neoplasia prior to any diagnostic procedure or investigation. However, this cannot be quantified, nor is it a plausible substitute to investigation. We aim to evaluate the association between instinct and diagnosis of cancer.

Method: A prospective study of patients in the outpatient department between August and December 2010 was performed. Patients requiring urgent procedures for suspected cancer were included. Risk factors, symptoms, signs, and the clinicians’ impression were recorded. This was graded from 1 (highly unlikely) to 10 (very likely) and subsequently correlated with histology.

Results: Twenty-seven patients underwent a diagnostic procedure. The mean age was 62.2 years. A total of 29.6% of the patients were referred under the 2-week rule. Of the patients, 18.5% had a previous history of head and neck cancer. The number of patients presenting with 1 symptom was 40.7%, with 2 symptoms was 40.7%, with 3 symptoms 11.1%, and with 4 symptoms 7.4%. A total of 37% of the patients had a cancer diagnosis. The procedure was cancelled for one patient because of illness. There was a positive correlation between clinical suspicion and cancer diagnosis (Kendall’s tau b = 0.648749). However, the number of symptoms did not correlate with abnormal histology (Kendall’s tau = −0.333333).

Conclusion: This study highlights the importance of clinical suspicion in diagnosis of cancer. Reliance on presence or absence of clinical signs alone may lead to missing a diagnosis. Although clinical suspicion cannot be quantified it should be regarded as an integral factor in patient management.