Intuition and the Practice of Medicine
"The most decisive actions of our life... are most often unconsidered actions." ~André Gide, The Counterfeiters, 1926
But is what Gide writes intuition? If “unconsidered actions” is really the consequences of intuition, is that what physicians use in making diagnoses and establishing treatment? A dictionary definition of intuition would be the act or faculty of knowing or sensing without the use of rational processes; immediate cognition. Knowledge gained by the use of this faculty; a perceptive insight or a sense of something not evident or deducible; an impression. Other words can also express intuition such as feeling, hunch, idea, impression or suspicion. But, do you think that these words describe what goes on in the mind of a physician when attending to a patient? My answer would be “well..yes, well..no”. First, there is debate as to how to define the word intuition when it is applied to the medical profession. Does it represent a “made-up” theory or assumption without any connection to previously established facts? Or is it a professional way to look at and interpret any facts that are available? Obviously, I can’t tell you what is going throughout the mind of any doctor except myself. To me, however, I find that I use intuition as a method in which I can personally make sense of the facts, both historical including my experience and contemporary. In medicine, simply laying out and evaluating the facts developed in taking a history, performing a physical examination and performing tests or procedures may be clearly insufficient toward coming to a conclusion. The diagnosis or the decision regarding further workup or treatment may still be ambiguous. It takes something more to feel confident to initiate action. That something more, I think, is intuition.
Intuition in medicine has nothing to do with ignoring or setting aside all the facts and proceeding de novo with some innate unexplained but significant mental mechanism which is “all knowing” or spiritual which has powers beyond any rational understanding of mental or physical mechanisms. I do think that intuition is related to the physician’s personal and professional experiences and recollection of the outcomes of those experiences. This recollection is then applied perhaps rightly or wrongly to the contemporary facts and an attempt is made to mold these facts with intuition into a conclusion for action.
Often, physicians must make critical decisions in short time spans during which time other needs for other decisions are appearing. There may not be enough time and the facts may be inadequate to come to a decision based on these facts. Particularly, in such a situation, doctors turn to intuition. This means that the doctor doesn’t simply look at A and B and C and automatically finds a direction toward action D because of established standards of professional practice or because A, B and C have been recognized and D has been rigorously tested in a controlled scientific study and found to be an appropriate action. This is where intuition plays a role. I say to myself "Will what I have learned in the past about this disease or symptom complex, will what I know about the patient, will what has been the standards of practice regarding this condition, and what has been tested and proven valid by scientific studies really apply to this patient and this patient’s condition?" I think it is intuition that then plays a role in getting a decision defined. It may become, as an answer to these questions, “yes, yes, yes, yes” or “yes, yes, yes,yes… but…” and it is the “but” which represents the physician’s use of intuition. My conclusion is that Gides “unconsidered actions” would not represent intuition particularly the way I have used intuition and the way I suspect other doctors have used it in medicine.
As a patient, how to you feel about the physician’s use of intuition, as you define it, and whether you think it is something that doctors should use? Do you have any examples of how your doctor’s intuition played a role in your illness? ..Maurice.