DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Intuition versus evidence

The astute readers knows that I have started with a false dichotomy.  I took the title from this rant – Intuition vs. Data-Driven Decision-Making: Some Rough Ideas

I like this paragraph:

My view is that intuition and analysis are not opposing perspectives, but tag team partners that, under the best conditions, where hunches are followed and then evaluated with evidence (both quantitative and qualitative, that is another issue, qualitative data are different than intuition, and often better) versus when hunches and ingrained behaviors are mindlessly followed and impervious to clear signs that they are failing.

We strive to use evidence in medicine, however any physician will admit that too often we do not, and possibly cannot, have evidence related to the decision at hand.  Intuition may not accurately describe our educated decision making.  We rely on experience, some data analysis, and then intuition.

Many readers know that I often resort to sore throat examples.  I know of too many patients who had “evidence based” diagnosis and treatment of sore throats, but really had key clues missed.  We use “evidence based” guidelines for testing and treatment, but do not understand when the guidelines no longer pertain.  Whether we call it intuition and clinical acumen, we must teach students and residents when the “evidence base” does not apply.

True evidence based medicine proponents understand that we cannot simply rely on simple algorithms.  We must weigh facts that do not fit the usual presentation to modify the guidelines.

In medicine, as in business, we must understand the situation rather than following a flow chart.  If you call understand the situational aspects intuition, then you can call me intuitive.  Intuition and evidence are not mutually exclusive.  In fact, part of what we are calling intuition is an understanding of when the evidence pertains to our patient.

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