Abstract of a literature study

Background

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 doctor’s 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  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.

Method

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.

Results

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.

Conclusion

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.

Referenties

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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).