How do disciplinary tribunals evaluate the "gut feelings" of doctors? An analysis of Dutch tribunal decisions, 2000-2008.

A sense of alarm, which is a form of "gut feeling" sometimes plays a part in the decisions of medical disciplinary tribunals in The Netherlands. Since these judgments are regarded as setting standards for professional attitudes in The Netherlands, the question arises how Dutch tribunals have evaluated gut feelings, and how tribunals in other European countries deal with them. An exploratory study searched two Dutch digital databases (2000-2008) and asked 26 national representatives of the European General Practice Research Network for information about the role of gut feelings in tribunals' decisions. A sense of alarm was mentioned in judgments in 34 Dutch cases. Defendants were hardly ever reproached for missing the correct diagnosis, but mostly for not acting in a professional manner. The sense of alarm was referred to as a diagnostic tool to assess a patient's situation, although the judgments indicate that it must be followed by further diagnostic steps. The role of gut feelings in decisions of disciplinary tribunals in Europe is unclear. The authors conclude that the sense of alarm as a diagnostic tool has been taken seriously by Dutch tribunals. Its timely development is considered to be an element of the professional standards for doctors.