Note: This article was originally published in TacitKey. Please view it here: Clinical Intuition
Clinical Intuition is one of the decision-making approaches healthcare professionals use, to process available information and diagnose patients. It is largely seen as automatic and associated with involuntary reflexes that these clinicians posses. Commonly referred as “gut feeling” or “inner voice”, researchers claim that intuition is an unconscious or subconscious process that warns the physician about what is currently happening or going to happen with the patient. These are the subtle signs that the doctor is able to recognize or “see through” the patient even if there are no overt manifestations or symptoms of a disease.
Some researchers say that though it may seem like a mysterious ability, physicians heavily rely on pattern recognition to diagnose the patient. With research evidence, they claim that the way physicians respond reflexively to what is presented before them is because of their previously acquired knowledge through medical studies and several years of clinical practice. Their unique expertise helps them discern patterns and subtle signs that may not be perceptible to the common eye. This approach has proven itself useful in time-sensitive instances like emergencies, crises and critical care.
In Psychotherapy, it is defined as “the capacity to pick up and respond to complex and subtle interpersonal patterns as guided by the right brain’s holistic, emotion- and arousal-regulating tendencies” (Marks-Tarlow, 2012).
Is Clinical Intuition The Best Approach To Diagnosis?
Other than the intuitive approach, there is the analytical approach to diagnosis that is deliberate, conscious, and calculated. This approach relies heavily on empirical evidence, so it is viewed as more reliable than the intuitive approach.
In this approach, when clinicians diagnose a patient, they collect the symptoms and create a list of probable disorders that could be affecting the patient at a given point of time. For instance, a fever could be dengue, viral, typhoid, or malaria. Then, they execute differential diagnoses where they utilize resources like tests, scans and data from secondary consultations to narrow their existing list down to find out the illness that is actually affecting the patient.
This approach proves to be taxing and impractical at times because a patient cannot be tested for malaria, dengue, viral fever or typhoid every time he or she runs a temperature. Some diseases do not even manifest with the complete range of symptoms for weeks together, so a particular disease may not show up on the medical reports early as well.
Though these two approaches are pitched against each other, in the hospital setting, they complement each other. Increasingly, healthcare professionals are using these approaches simultaneously for diagnosis and clinical decision-making. In order to provide high-quality care, these clinicians have to strike a balance between using the two approaches. While it is impractical to order an MRI scan for every patient with a headache, intuitively deciding that every one of him or her has a migraine is a wrong diagnosis. Healthcare practitioners must learn to alternate between the two approaches when necessary. That can happen only if they are aware of how their cognitive biases can cause errors in clinical evaluation.
Does research favor Clinical Intuition?
There is limited research on the role of intuition in healthcare because doctors are reluctant to discuss about it. Though they discuss with their colleagues about clinical intuition in a private and safe setting, they do not openly share their assessment processes keeping the society in mind. The patients, hospital management boards, medical authorization bodies and public—with their attitudes, stereotypes and prejudices—do not consider intuition to be a legitimate part of clinical decision-making procedures. However, the nursing field has proven to be an exception where there is considerable research available regarding the topic in question.
Some researchers claim that clinical intuition is important in healthcare settings:
BMJ.com (formerly British Medical Journal) published a research in 2012 suggesting that doctors should act upon their gut feelings instead of ignoring them, when treating children in primary care.
A study by Amanda Woolley and Olga Kostopoulou conducted in 2013, “Clinical Intuition in Family Medicine: More Than First Impressions”, claims that clinical literature does not recommend the use of intuition. That is because such intuitive thought is associated with early impressions that doctors get when they diagnose a patient (the first thing that comes to a physician’s mind during diagnosis). However, the results of the study disprove such a claim showing that such automatic intuitive thoughts are not merely just first impressions. These intuitive thoughts include:
- gut feelings where a warning throws caution that there is something wrong with the patient and that further investigation is needed
- recognition where physicians arrive at diagnosis quickly through heuristic decision-making that involves pattern recognition
- Insights physicians execute differential diagnoses but are unable to infer anything from such extensive data. However, they suddenly get clarity and inexplicably arrive at a solution after some singular and distinct information surfaces to their conscious awareness.
The study suggests that research should be conducted to explore the factors that would deem a clinical intuition to be accurate or otherwise.
Nydia van den Brink and Anne Schuurman conducted a literature study titled, “The role of intuitive knowledge in diagnostic reasoning of hospital specialists: process and result”. According to the study, clinical settings use intuitive reasoning widely and acknowledge it as a significant part of decision-making processes. The study suggests that research on intuition will help reduce medical errors. Additionally, medical schools should teach students to handle intuitive reasoning better through proper training.
Some other researchers claim that Intuitive decision-making is prone to biases:
A study titled “The Perception of Intuition in Clinical Practice by Iranian Critical Care Nurses: a Phenomenological Study” in 2016, aimed to explore how well Iranian critical care nurses understood intuition in clinical practice. The conclusion was that the nurses understood intuition as “feeling”, “thought”, “sign” or “alarm”. They understood it as an automatic response derived subconsciously and could not articulate it well. These nurses acted upon it based on cues from their senses, and physical and psychological signs. The research suggests that clinicians have to be taught to understand intuition in the first place so that they act on it effectively without biases.
A study conducted by Carl Thompson and Huiqin Yang in 2009 titled, “Nurses’ Decisions, Irreducible Uncertainty and Maximizing Nurses’ Contribution to Patient Safety” suggests that nurses play an integral part in contributing to patients’ safety especially when they intervene on clinical uncertainties. These nurses are taught to handle uncertainties intuitively and that poses as a problem because intuitive decision-making is prone to biases. The nurses do not do well especially if the circumstances are critical with time constraints. The study concludes that more research should be done on nurses’ intuitive decision-making processes to spot the flaws in the approach. It also suggests that hospitals and other stakeholders should train nurses in clinical decision-making in order to maximize patients’ safety.
Can One Rely on Clinical Intuition?
Healthcare professionals use their clinical intuition everyday but are not inclined towards acknowledging that openly to the public. The limited medical literature available on clinical intuition refers to it as an involuntary, reflexive approach arising from the deeper levels of our conscious. Clinicians claim that they use intuitive and analytical approaches that complement each other in diagnosis, treatment, and care.
Though the intuitive approach is partially unreliable, clinicians do not want to do away with it. In fact, literature suggests that medical schools should train health care providers on critical thinking and intuitive decision-making etc., in order for them to understand the nature of clinical intuition and be aware of their cognitive biases while taking medical decisions.