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In a retrospective analysis of 502 surgical malpractice claims, the contribution of intuition was assessed. It was found that intuition, as a logical and directed intellectual approach, had an overall positive effect; this was not the case with an attitude of autistic intuition. However, judgement based on the physicians intuition alone did never result it negligence or misconduct.
Intuition is a decision-making method that is used unconsciously by experienced practitioners but is inaccessible to the novice. It is rapid, subtle, contextual, and does not follow simple, cause-and-effect logic. Evidence-based medicine offers exciting opportunities_for improving patient outcomes, but the 'evidence-burdened' approach of the inexperienced, protocol-driven clinician is well documented Intuition is not unscientific. It is a highly creative process, fundamental to hypothesis generation in science. The experienced practitioner should generate and follow clinical hunches as well as (not instead of applying the deductive principles of evidence-based medicine. The educational research literature suggests that we can improve our intuitive powers through systematic critical reflection about intuitive judgements--for example, through creative writing and dialogue with professional colleagues. It is time to revive and celebrate clinical storytelling as a method for professional education and development. The stage is surely set for a new, improved--and, indeed, evidence-based--'Balint'group.
This article is a synthesis of nursing and management research findings on intuition and explains why intuition is particularly useful in crisis management. Drawing on applications from organizational psychology, it includes ways to enhance the nurse's ability to exercise and develop intuitive skills. The authors assert that the highly complex, rapidly changing, and often unpredictable circumstances that require crisis management in nursing are best met through applying the complementary cognitive skills of analytic reasoning and intuition.
The paper sets out to explore the place of intuition in coronary care nursing. The Dreyfus (1985) and Benner (1984) models are used to explore the relevance of intuition to clinical practice. Examples from clinical practice are used to discuss the status of intuition in current practice. Conclusions suggest that further work is needed to explore the value of intuition and its contribution to clinical care.
OBJECTIVE: To assess the diagnostic value of standardized diagnostic criteria compared with the clinical intuitive diagnosis for verrucae vulgaris. DESIGN: A blind comparison with cross-over of experienced dermatologists using either intuitive clinical diagnosis or else recording the presence of standardized diagnostic criteria in verrucae vulgaris. SETTING: Clinical outpatient department in a major teaching hospital. PATIENTS: Fifteen patients aged 6 to 60 years with 21 verrucae vulgaris and 24 control lesions. INTERVENTION: Dermatologists examined the lesions and recorded either the diagnosis by the usual clinical intuitive method or else whether standardized diagnostic criteria were present in the lesion of each patient. Each dermatologist did 1 only of the 2 methods for each lesion with the other doing the alternative method for the same lesion, neither of them having previously been aware of any of the diagnoses. MAIN OUTCOME MEASURE: The sensitivity, specificity, and positive predictive, negative predictive, and relative values for each diagnostic approach were compared. RESULTS: Use of intuitive clinical diagnosis resulted in 100% specificity, sensitivity, and positive predictive, negative predictive, and relative values for both the verrucae vulgaris and the control lesions. Recording the presence of the diagnostic criteria reduced to a varying extent all the parameters of diagnostic accuracy with site--fingers and hands, elbows, and knees--being the most efficacious of the criteria. CONCLUSIONS: These data indicate that care is required in relying too much on standardized criteria as the basis for clinical diagnosis, even for a lesion as simple as a wart. They also reinforce the value of clinical experience obtained from repeated exposure to multiple variants of a disease in the traditional bedside teaching model.
This study examines the intuitive combination of human judgment and mechanical prediction under varied information conditions. As expected, mechanical prediction outperformed human intuition when based on the same information, but a combined approach was best when judges had access to relevant information not captured by the model (information asymmetry). The model was useful for differentiating between the event outcomes (improved slope), while eliminating the bias caused by base-rate neglect. Human intuition was useful for incorporating relevant information outside the scope of the model, resulting in improved slope and reduced judgment scatter. The addition of irrelevant information was detrimental to judgment accuracy, causing an increase in bias and a reduction in slope. These results provide insight into how and when combining mechanical prediction and human intuition is likely to result in improved accuracy. Copyright 1998 Academic Press.
Clinical trials are often used to evaluate the efficacy of a given treatment. The results of clinical trials however do not always agree with a clinician's experience or intuition. The merits and demerits of Clinical Trials versus Intuition are discussed by using the laser photocoagulation trials of Proliferative Diabetic Retinopathy, Central serous retinopathy, Branch Vein Occlusion (treatment for macular oedema), Senile Macular Degeneration, and Pigment Epithelial Detachment. A model based on Intuition is used to explain the discrepancy between the results of the British and American trials of Branch Vein Occlusion and Senile Macular Degeneration. Proposals on the presentation of Clinical Trials and the place of Intuition are made.
CONTEXT: Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences. PURPOSE: To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education. CONTENT: Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making. CONCLUSIONS: It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.
After Mischel's (1968) critique of the traditional concept of personality, others have attempted to resolve the apparent discrepancy between intuitive (and theoretical) notions of consistency in the behavior patterns of individuals, and the available empirical evidence, much of which seems to suggest that the intuitive/theoretical notions are erroneous. Virtually all of these attempts have been grounded ultimately in some variation of the individual differences paradigm that has long dominated empirical personality research. In contrast, the present article suggests that this apparent discrepancy results from an attempt to reconcile essentially idiographic intuitions with aggregate empirical findings. Going beyond previous conceptual discussions of this point, the present article offers an empirical illustration of the problem, and suggests that the intuitions vs. empirical evidence discrepancy regarding questions of (in)consistencies in personality reflects the "incorrectness" of neither, but rather the fact that the intuitions and empirical evidence speak to fundamentally different questions. The implications of this fact for programmatic, theoretically oriented personality research are emphasized.
This article is a synthesis of nursing and management research findings on intuition and explains why intuition is particularly useful in crisis management. Drawing on applications from organizational psychology, it includes ways to enhance the nurse's ability to exercise and develop intuitive skills. The authors assert that the highly complex, rapidly changing, and often unpredictable circumstances that require crisis management in nursing are best met through applying the complementary cognitive skills of analytic reasoning and intuition.
Intuition is used in medical decision-making, especially in a decision for surgery and in selection of the surgical procedure. Intuitive decisions are made without reasoning. They are often correct if the prerequisite experience and knowledge are available to the physician. Intuition is related to heuristic techniques and uses them (representativeness, availability, anchoring). Decisions made on the basis of intuition must be controlled by systematic and logical reasoning.
Making clinical nursing judgements is central to the practice of nursing, and critical thinking skills are essential to making clinical judgments. Qualitative studies have shown that the use of intuition in making clinical nursing judgments is an important part of the critical thinking process. This descriptive correlational study examines the relationships between the use of intuition in clinical judgment-making and characteristics of the nurse, such as level of nursing proficiency and years of clinical experience. Findings support Benner's (1984) model of skill acquisition as well as prior findings of studies on the use of intuition in clinical nursing practice. Thus, as the level of nursing proficiency increases from beginner to expert and as the amount of clinical experience increases, the use of intuition to make clinical nursing judgments increases significantly.
In many situations, quantity estimates from multiple experts or diagnostic instruments must be collected and combined. Normatively, and all else equal, one should value information sources that are nonredundant, in the sense that correlation in forecast errors should be minimized. Past research on the preference for redundancy has been inconclusive. While some studies have suggested that people correctly place higher value on uncorrelated inputs when collecting estimates, others have shown that people either ignore correlation or, in some cases, even prefer it. The present experiments show that the preference for redundancy depends on one's intuitive theory of information. The most common intuitive theory identified is the Error Tradeoff Model (ETM), which explicitly distinguishes between measurement error and bias. According to ETM, measurement error can only be averaged out by consulting the same source multiple times (normatively false), and bias can only be averaged out by consulting different sources (normatively true). As a result, ETM leads people to prefer redundant estimates when the ratio of measurement error to bias is relatively high. Other participants favored different theories. Some adopted the normative model, while others were reluctant to mathematically average estimates from different sources in any circumstance. In a post hoc analysis, science majors were more likely than others to subscribe to the normative model. While tentative, this result lends insight into how intuitive theories might develop and also has potential ramifications for how statistical concepts such as correlation might best be learned and internalized.
The role of emotion in complex decision-making can be assessed on the Iowa Gambling Task (IGT), a widely used neuropsychological measure that may tap a different aspect of executive function than that assessed by conventional measures. Most notably, the 'feeling' about which decks are good or bad, often described in relation to IGT performance, seems reminiscent of decision-making based on intuition-linked to a long history of research in decision-making contrasting the 'intuition' versus 'reasoning' styles of problem solving. To test the claim that the performance on the IGT relies more on emotion-based learning than conventional executive resources for normal performance, a group of participants completed the IGT simultaneously with one of two secondary-tasks, one of which (random number generation) is known to load executive resources. A third group performed the IGT with no secondary-task. If performance on the IGT requires the properties associated with intuitive operations, then participants should either show no disruption when completing a secondary-task, or at least show no selective disruption on a secondary-task that loads for executive function. The rate of learning in the three groups was not significantly different. This suggests that the sorts of cognitive resources loaded by traditional executive tasks such as random number generation do not overlap, in the cognitive architecture, with the emotion-based learning skills that are required for Iowa Gambling Task performance. The findings of the present study are also consistent with a previous claim of the Iowa group that emotion-based learning and working memory resources are doubly dissociable.
Analytic philosophers have long used a priori methods to characterize folk concepts such as knowledge, belief and wrongness. Recently, researchers have begun to exploit social scientific methodologies to characterize such folk concepts. One line of work has explored folk intuitions with cases that are disputed within philosophy. A second approach, with potentially more radical implications, applies the methods of cross-cultural psychology to philosophical intuitions. Recent work in this area suggests that people in different cultures have systematically different intuitions surrounding folk concepts. A third strand of research explores the emergence and character of folk concepts in children. These approaches to characterizing folk concepts provide important resources that will supplement, and perhaps in some cases displace, a priori approaches.
Von Economo neurons (VENs) are a recently evolved cell type which may be involved in the fast intuitive assessment of complex situations. As such, they could be part of the circuitry supporting human social networks. We propose that the VENs relay an output of fronto-insular and anterior cingulate cortex to the parts of frontal and temporal cortex associated with theory-of-mind, where fast intuitions are melded with slower, deliberative judgments. The VENs emerge mainly after birth and increase in number until age 4 yrs. We propose that in autism spectrum disorders the VENs fail to develop normally, and that this failure might be partially responsible for the associated social disabilities that result from faulty intuition.
An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. In this paper we evaluate the relative importance of intuition and systematicity in informed consent. We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.
The article relates the terms intuition, tacit knowledge and experience and describes their meaning for nursing. An empirical study with 16 experienced nurses is presented whereby the nurses had to deal with a simulated critical nursing situation. Basing on their actions a method for explication of action-guiding tacit knowledge was developed so that a closer scrutinizing of this type of knowledge became possible. Results underline the assumption of many practitioners that intuition as a resource in nursing activities is not to underestimate. At the same time a warning is given: Intuition and tacit knowledge is not always and at all times to evaluate positively. Finally, this differentiated point of view is discussed regarding consequences for nursing practice.