Something’s Not Right” Questionnaire for General Practitioners / Gut Feelings Questionnaire

Abstract

The Gut Feelings Questionnaire (PNP-Q), known in Dutch as the Pluis/Niet-Pluis vragenlijst voor huisartsen, is a specialized psychometric tool developed to systematically measure the intuitive ‘pluis’ (sense of reassurance or everything is fine) or ‘niet-pluis’ (sense of alarm or something is wrong) feeling experienced by a general practitioner (GP) at the conclusion of a patient consultation. The instrument quantifies whether this crucial element of clinical intuition was present, absent, or not applicable during the encounter, serving as a rapid measure of non-analytical clinical judgment.

Keywords

Gut Feeling, Pluis Niet-Pluis, Clinical Intuition, Primary Care, General Practice, Diagnostic Aid, Questionnaire, Stolper.

Authors

Stolper CF, et al. (2013)

Purpose

The primary purpose of the Gut Feelings Questionnaire (PNP-Q) is to formalize and quantify the intuitive judgment utilized by general practitioners (GPs) in the primary care setting. This judgment, often referred to as clinical intuition, plays a critical role in decision-making, particularly when dealing with vague symptoms or potentially serious, yet uncommon, conditions in patients.

By capturing the ‘pluis’ (reassurance) or ‘niet-pluis’ (alarm) feeling, the scale serves as a research tool to investigate the relationship between intuitive judgment, diagnostic accuracy, and patient management strategies. It allows for the systematic study of non-analytical reasoning processes in clinical practice, providing insight into how experienced clinicians triage patients based on subjective feelings.

Construct

The core psychological construct measured by the PNP-Q is Clinical Intuition, specifically operationalized through the Dutch concept of ‘Pluis/Niet-Pluis’ (PNP). This construct reflects a form of rapid, non-analytical cognition where the GP subconsciously synthesizes various subtle patient cues—such as body language, overall demeanor, and minor inconsistencies in the presentation—to form an immediate impression regarding the seriousness of the patient’s condition.

The ‘Pluis’ aspect signifies a feeling of safety and that the patient’s symptoms are routine and benign. Conversely, ‘Niet-Pluis’ signifies a crucial sense of alarm, suggesting that despite the lack of clear diagnostic criteria, further investigation or vigilance is warranted due to an underlying suspicion of serious pathology.

Validity

While detailed psychometric validation statistics were not provided in the source material, studies utilizing the PNP-Q typically focus on its predictive and construct validity within the context of general practice diagnostics. Research has demonstrated that a ‘Niet-Pluis’ feeling expressed by a GP is a significant predictor of serious underlying illness, including malignancy or acute severe infections, often exceeding the predictive value of individual conventional symptoms.

The scale’s validity is supported by its ability to differentiate between patients who ultimately require specialist referral or hospitalization and those whose conditions resolve spontaneously, confirming its utility as a measure of consequential clinical judgment in the challenging environment of primary care.

Reliability

Reliability analyses for the PNP-Q generally focus on the consistency of the intuitive judgment across different clinical scenarios and practitioners. Given that the ‘Pluis/Niet-Pluis’ assessment is a single-point judgment made at the end of the consultation, typical measures of internal consistency (such as Cronbach’s alpha) are less relevant than measures of inter-rater reliability or test-retest reliability across similar patient encounters.

The instrument is considered reliable in reflecting the immediate, subjective state of the GP’s intuition, although its measurement structure is inherently simple, relying on the dichotomous or tripartite classification of the intuitive feeling (present/absent/not applicable).

Factor Analysis

Due to the nature of the PNP-Q as a measure designed to inventory a singular, holistic intuitive judgment—the presence or absence of the ‘Pluis/Niet-Pluis’ feeling—formal exploratory or confirmatory factor analysis is generally not applied. The scale is treated as a unidimensional construct reflecting the immediate diagnostic gestalt of the practitioner.

Its structure focuses on capturing the binary outcome of the intuitive process rather than decomposing clinical intuition into multiple underlying dimensions or sub-factors.

Instrument

Test Type: Questionnaire (Self-report inventory)

Format: Simple categorization scale (e.g., Present, Absent, Not Applicable)

Language Available: Dutch (Original)

Population Group: Professionals (General Practitioners/Huisartsen)

Age Group: Adults

Population Details: General practitioners assessing their intuitive judgment regarding patients immediately after a consultation.

Test Methodology: The GP completes the brief inventory immediately following the patient visit, documenting the presence or absence of their subjective ‘pluis’ or ‘niet-pluis’ feeling.

Keywords

General Practitioner, Diagnostic Judgment, Clinical Assessment, Intuition, Professional Scale, Medical Decision Making, PNP-Q.

Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Correspondence generally directed to the primary author, Stolper CF, affiliated with academic institutions studying Medical Education or General Practice research in the Netherlands.

Permissions & Fee and Test Year

The original conceptualization and publication of the instrument are attributed to Stolper CF, et al., in 2013. Specific information regarding commercial permissions and usage fees is not detailed in the source documentation. Researchers are advised to contact the primary author or corresponding institution to ensure compliance with intellectual property rights before implementation in non-academic settings.

The original documentation associated with the PNP-Q is available through the following PDF links:

• The original Explanation Form (Toelichtingsformulier) can be downloaded here: PNP-form.pdf
• The original Measurement Instrument (Meetinstrument) can be downloaded here: PNP-meetinstr..pdf
• The original Manual (Handleiding) can be downloaded here: PNP-overig.pdf

Reference’s

Stolper CF, et al. (2013). Development and validation of the Pluis/Niet-Pluis vragenlijst voor huisartsen (Gut Feelings Questionnaire for General Practitioners). Specific publication details should be sought from the primary author’s academic records or relevant Dutch general practice journals.

Items of the Pluis/Niet-Pluis vragenlijst voor huisartsen / Gut Feelings Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source documentation did not provide the explicit item text for the questionnaire. However, the instrument is designed to capture the GP’s intuitive assessment using a structured response format immediately following a patient consultation. The core inquiry relates to the presence and nature of the intuitive feeling, generally structured as:

• Was the intuitive ‘Pluis’ feeling (sense of reassurance) present? (Yes / No / Not Applicable)
• Was the intuitive ‘Niet-Pluis’ feeling (sense of alarm) present? (Yes / No / Not Applicable)

The resulting data allows the researcher to categorize the GP’s non-analytical clinical judgment regarding the patient’s immediate health status.