'Niet-pluis'-gevoel tuchtrechtelijk gewogen

The sense that 'something does not fit it', which is a form of gut feelings, is frequently mentioned in judgements made by medical disciplinary tribunals as reported in the Dutch medical journal Medisch Contact. Since judgements made by these tribunals are regarded as setting the standard for good professional practice, we investigated the way in which they include and evaluate these feelings when making judgements. Exploratory, descriptive investigation. A search was performed for the term 'niet-pluis' ('something does not fit it') in medical tribunal databases and the Medisch Contact archives for the period 2000-2008. The tribunal judgements found were analysed and classified. A feeling that 'something does not fit it' was mentioned in judgements in 34 cases, all relating to situations involving diagnostic uncertainty or diagnostic mistakes. In almost every case this involved potential or actual serious damage to health. In 19 cases disciplinary action was imposed in the final judgement. Disciplinary tribunals regarded the sense of 'something does not fit it' as a diagnostic instrument. This should be objectified by taking a detailed case history and carrying out a physical examination and should be recorded in the files. Medical disciplinary tribunals regarded the sense of 'something does not fit it' as part of the professional standard