Abstract of a literature study
Diagnostic reasoning is one of the most important skills a doctor has to possess. Recent literature tells us that during the process of diagnostic reasoning, doctors use several methods, which can be classified along a continuum from analytical to non-analytical reasoning; this is known as the dual process theory. One of the non-analytical methods is intuition. But what role does intuition play in this important aspect of a doctorâs work? There has been a great deal of research on intuition and the role it plays in the work of general practitioners and nurses. But what is its role in the work of specialists? Is there a difference between Â disciplines? Does the use of intuition not run counter to evidence-based medicine (EBM) and does it not lead to diagnostic errors? These are the questions we wanted to answer with our research.
We systematically searched the existing literature via PubMed. We used a search strategy involving terms describing the following subjects: intuition, several disciplines and diagnostic reasoning. Only articles about specialist medicine and the use of intuition during diagnostic reasoning were included.
The little evidence available about this subject shows that intuitive reasoning plays a significant role during diagnostic reasoning in specialist medicine. However, intuitive reasoning and analytical reasoning are not mutually exclusive, and both methods are being used. Often, intuition has to be used out of necessity, for example in urgent situations, when there is little time, or in complex situations. Intuitive reasoning is a very sensitive and specific method. Experienced doctors make more use of intuition, based on their experience. When EBM cannot be used in a particular situation, doctors rely more on intuition and experience. A disadvantage of intuitive reasoning is that it is very sensitive to errors.
Based on the little evidence available, we conclude that intuitive reasoning is a widely used and necessary method of diagnostic reasoning. It is therefore important that is it acknowledged as a valid part of clinical decision making. More research into the role of intuition in the diagnostic process of specialists is definitely necessary. This research can also be used to reduce medical errors caused by the pitfalls of analytical as well as intuitive diagnostic reasoning. If we knew more about this subject, medical students could be taught to handle the intuitive aspects of diagnostic reasoning better.
- Croskerry, P., A universal model of diagnostic reasoning. Acad Med, 2009. 84(8): p. 1022-8.
- Grube, M., Towards an empirically based validation of intuitive diagnostic: Rumke’s ‘praecox feeling’ across the schizophrenia spectrum: preliminary results. Psychopathology, 2006. 39(5): p. 209-17.
- Srivastava, A. and M. Grube, Does intuition have a role in psychiatric diagnosis? Psychiatr Q, 2009. 80(2): p. 99-106.
- Wiswell, J., et al., “Sick” or “not-sick”: accuracy of System 1 diagnostic reasoning for the prediction of disposition and acuity in patients presenting to an academic ED. Am J Emerg Med, 2013. 31(10): p. 1448-52.
- Croskerry, P., Context is everything or how could I have been that stupid? Healthc Q, 2009. 12 Spec No Patient: p. e171-6.
- Calder, L.A., et al., Experiential and rational decision making: a survey to determine how emergency physicians make clinical decisions. Emerg Med J, 2012. 29(10): p. 811-6.
- Crebbin, W., S.W. Beasley, and D.A. Watters, Clinical decision making: how surgeons do it. ANZ J Surg, 2013. 83(6): p. 422-8.
- Pelaccia, T., et al., An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory. Med Educ Online, 2011. 16.
- Mamede, S., et al., Breaking down automaticity: case ambiguity and the shift to reflective approaches in clinical reasoning. Med Educ, 2007. 41(12): p. 1185-92.
- Bhugra, D., et al., Clinical decision making in psychiatry by psychiatrists. Acta Psychiatr Scand, 2011. 124(5): p. 403-11.
- Norman, G.R. and K.W. Eva, Diagnostic error and clinical reasoning. Med Educ, 2010. 44(1): p. 94-100.
- Alderson, D., Developing expertise in surgery. Med Teach, 2010. 32(10): p. 830-6.
- Maslovitz, S., et al., Improved accuracy of postpartum blood loss estimation as assessed by simulation. Acta Obstet Gynecol Scand, 2008. 87(9): p. 929-34.
- Van den Bruel, A., et al., Signs and symptoms for diagnosis of serious infections in children: a prospective study in primary care. Br J Gen Pract, 2007. 57(540): p. 538-46.
- Thompson, M., et al., Systematic review and validation of prediction rules for identifying children with serious infections in emergency departments and urgent-access primary care. Health Technol Assess, 2012. 16(15): p. 1-100.
- Flin, R., G. Youngson, and S. Yule, How do surgeons make intraoperative decisions? Qual Saf Health Care, 2007. 16(3): p. 235-9.
- Norman, G., M. Young, and L. Brooks, Non-analytical models of clinical reasoning: the role of experience. Med Educ, 2007. 41(12): p. 1140-5.
- Eva, K.W. and J.P. Cunnington, The difficulty with experience: does practice increase susceptibility to premature closure? J Contin Educ Health Prof, 2006. 26(3): p. 192-8.
- Sladek, R.M., et al., Thinking styles and doctors’ knowledge and behaviours relating to acute coronary syndromes guidelines. Implement Sci, 2008. 3: p. 23.
- Croskerry, P., Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv Health Sci Educ Theory Pract, 2009. 14 Suppl 1: p. 27-35.
|1||Croskerry, P.||2009||Algemeen||Literatuur||2, 4|
|2||Grube, M.||2006||Psychiatrie||Diagnostisch vergelijkend||1, 4|
|3||Srivastava, A.||2009||Psychiatrie||Case example||1|
|4||Wiswell, J.||2013||Urgentiegeneeskunde||Prospectief observationeel||1, 2, 4|
|6||Calder, L.A.||2012||Urgentiegeneeskunde||EnquĂȘte||1, 2|
|7||Crebbin, W.||2013||Heelkunde||Literatuur||1, 2, 4|
|9||Mamede, S.||2007||Interne geneeskunde||Experimental||1, 2, 4|
|10||Bhugra, D.||2011||Psychiatrie||Interviews||1, 3, 4|
|13||Maslovitz, S.||2008||Obstetrie||Prospectief||1, 2|
|14||Van den Breul, A.||2007||Huisarts geneeskunde/ Pediatrie||Prospectief||1|
|15||Thompson, M.||2012||Pediatrie||Systematic review||1|
|18||Eva, K.W.||2006||Algemeen||Prospectief||2, 4|
The role of intuitive knowledge in diagnostic reasoning of hospital specialists: process and result, by Nydia van den Brink and Anne Schuurman.(master students medicine University of Antwerp).