How important to you think intuition is in making a diagnosis in difficult cases

[doctorhouse]

important and comes with experience and expertise?

or do you think it's a bunch of crap?

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[Law2Doc]

important and comes with experience and expertise?

or do you think it's a bunch of crap?

Intuition isn't evidence based. We don't practice on hunches per se. However if you are talking about making decisions based on nonspecific findings, I'd say doctors do that all the time. You very often have to act on the info you have which is incomplete. You use your knowledge and experience to make these decisions but you are often going to be starting treatment without complete info. Does that constitute intuition?

 

[colbgw02]

important and comes with experience and expertise?

or do you think it's a bunch of crap?

Intuition that comes with experience isn't intuition. It's experience.

 

[deleted109597]

I think you're using the wrong word.
Intuition means without inference or use of reason.

We don't do that. Sure, we may have "gut feelings" that are in the face of objective data, but usually that's experiential learning.

 

[Top Gun]

What you call intuition is really experience. In other words, having seen the same presentation many times before so that, without any further testing, you know what the diagnosis is.

 

[doctorhouse]

Yeah, maybe I didn't choose the right word.

 

[docB]

I think many of us use intuition tempered with experience a lot. In EM making decisions in a vacuum of information is part of the specialty. Other specialties have similar amounts of guessing and some have much less.

 

[KluverB]

Beware the cognitive biases that come with this so called "intuition". I don't have the time to expound on them here. However, there is an excellent book, "How Doctors Think" by Jerome Groopman, that speaks to these issues.

 

[J-Rad]

Beware the cognitive biases that come with this so called "intuition". I don't have the time to expound on them here. However, there is an excellent book, "How Doctors Think" by Jerome Groopman, that speaks to these issues.

+1

I think everyone should read this once in the first two years of medical school, once toward the end of medical school and at least once more while in residency/fellowship. I can quibble with small points in the book, but en toto, I think it's a valuable and insightful read.

As to intuition and experience, I'm not sure that the two are identical. I think the former can be informed by the latter (as it can be informed by other areas of knowledge such as book reading, life experience, etc.) but I think the "intuition" that we see in those that seem to be master diagnosticians isn't just accurate "gut feelings". I see it as something akin to those people who are "human lie detectors" (http://www.msnbc.msn.com/id/6249749...e/t/wizards-can-spot-signs-liar/#.T6VU09nkqF8). They pick up on the subtle nuances that don't declare themselves obviously and they pick them up quickly to turn around and rapidly synthesize that data it make plans based upon it. I think we all know many experienced and wise physicians who don't quite have that talent (and are still good doctors despite that) so while experience and intuition are intertwined, they don't seem synonymous in my mind. Those that don't have that degree of "intuitive" talent become good doctors with experience and lifelong learning (not of the MOC-crap variety). Everybody is a better doctor when they realize how and when their experience and intuition is going to fail them (as alluded to by KB)

 

[lowbudget]

Algorithms, protocols, guidelines, and computer models can't replace intuition.

 

[jdh71]

Not everyone has the same intuitive powers. In fact, based on personality assessments of most of the people in medicine, they are low in intuition and have no business using it.

 

[docB]

Beware the cognitive biases that come with this so called "intuition". I don't have the time to expound on them here. However, there is an excellent book, "How Doctors Think" by Jerome Groopman, that speaks to these issues.

Another good book Blink by Malcolm Gladwell talks about how often intuition is correct . It's used by doctors, pilots, cops, soldiers, etc. and the vast majority of the time it works well. It is true that failures are catastrophic but for these fields (e.g. EM) where making some sort of judgement quickly and proceeding from there is mandatory intuition tempered by experience is usually all we have early on before we begin to collect data.

Remember that experience also allows you to back yourself up, e.g. it seems like a stroke but I'm sending tests for metabolic causes of altered mental status as well. You have to make a snap decision but you can also cast a wider net. Medicine more allows us that luxury more than flying or fighting.

 

[surftheiop]

Another good book Blink by Malcolm Gladwell talks about how often intuition is correct . It's used by doctors, pilots, cops, soldiers, etc. and the vast majority of the time it works well. It is true that failures are catastrophic but for these fields (e.g. EM) where making some sort of judgement quickly and proceeding from there is mandatory intuition tempered by experience is usually all we have early on before we begin to collect data.

Remember that experience also allows you to back yourself up, e.g. it seems like a stroke but I'm sending tests for metabolic causes of altered mental status as well. You have to make a snap decision but you can also cast a wider net. Medicine more allows us that luxury more than flying or fighting.

Great author, but not sure if that book is particulary strong support for trusting our intuition. Did you read the chapter of blink when he talked about how blindly following a statistically determined super simple algorithm gave better MI diagnosis than experienced ER docs using their judgement? (It was several years ago that I read it, so I could be remembering something wrong)

 

[MidwestFM]

Experience is important As we begin to recognize the patterns of how a certain illness presents we develop "illness scripts". (i.e. this is what someone looks like when they have a kidney stone.) When everything fits, it is easy to make the diagnosis.
A good diagnostician uses his/her experience to recognize when something important DOESN'T quite fit in some way. And then they don't ignore that information. It is human nature to discount the importance of information that confounds the initial easy diagnosis.
It might seem like intuition, but I would say those who are good at this are the ones with a broad differential and keep questioning.
(Sometimes that "kidney stone" turns out to be a AAA or an ectopic pregnancy)

 

[KluverB]

Algorithms, protocols, guidelines, and computer models can't replace intuition.

Of course they can. They will. They could already supplant much of what is being done out there today, there just isn't much support from major stakeholder, ie. physicians, for obvious reasons.

The same argument comes up in fields like air flight, for example. Modern planes can takeoff, fly, and land all by themselves in conditions in which no human pilot could ever be able to... and yet.... Most pilots would argue they would never give up control to a computer to take off or land.

So, it is with physicians. And so patients, at times, suffer and die, sometimes unnecessarily, because humans make mistakes. And don't get me wrong, an algorithm or a model is only as good as the human that created it (for now). But, at least an algorithm/model would be consistent and would not be subject to the types of bias that have a way of blindsiding even expert physicians.

The singularity is coming. Embrace it.