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In the medical world, clinical intuition is finally being given the respect it deserves.
Whether we call it instinct, sixth sense, or strong hunch, new research suggests the existence of a process that involves snap judgments and perceptions that occur outside of conscious knowledge; a way of knowing something without knowing that you know it. The value of clinical intuition in medicine is currently being investigated and is becoming increasingly important as interest grows in developing artificial intelligence systems capable of analyzing medical data to diagnose or treat patients.
A study published in the journal in 2023 Journal of Clinical Medicine showed that physical therapists’ clinical intuition regarding the prognosis of functional recovery in patients with disorders due to cervical trauma was closely linked to the development of the patients’ recovery after their accident. Another study published in 2023 in the journal Journal of the American College of Surgeons, concluded that, in contrast to the use of clinical data in isolation (e.g., a patient’s comorbidities and risk factors), “the surgeon’s preoperative intuition alone represents an independent predictor of patient outcome.”
“It’s a cognitive process. Clinical intuition is about expertise, knowledge, and pattern recognition that accumulates with experience. The mind collects all kinds of information and organizes it in order to be able to explain it.This person is really sick“…or not,” says Meredith Vanstone, a lecturer in the department of family medicine at McMaster University in Hamilton, Ontario, who also studies clinical intuition.
Given the depth of this cognitive process, some experts doubt that artificial intelligence can make medical decisions as well as a human doctor.
“By accumulating years of interactions with patients and thousands of cases, these intuitions become a kind of summary of all the experiences they have had,” notes Mohammed Ghassemi, who researches medical decision-making and the use of artificial intelligence in healthcare at Michigan State University. “Doctors can observe various things that are not always captured or expressed by machines. » These details that the machine misses may include the patient’s appearance and behavior, such as posture, facial expression, and verbal responses to questions.
Some healthcare professionals rely on their intuition more than others. In a study published in the journal health psychology and behavioral medicine, Researchers found that doctors and nurses who work in a medical specialty that has a high emergency probability or complexity dimensions (anesthesiology, obstetrics, neurology, and critical care) are more likely to use intuitive decision-making in their practice.
“We surgeons say that the first thing we have to do is look at the patient because the structured data may not match what we see during the examination,” says Gabriel Brat, a trauma and critical care specialist and professor of computer science at Harvard University School of Medicine. “My ability to do this comes from many years of assessing patients and developing an internal reference of what a person with a particular disease condition looks like. »
In a study of thirty emergency physicians, internists, and general practitioners, Meredith Vanstone and her colleagues asked participants how they practice medicine using their intuition. The research team found that experienced physicians have no shortage of stories about “an inkling of a diagnosis that alerted them to unusual diagnoses, previous misdiagnoses, or deleterious outcomes.” »
“In emergency medicine, intuition is an extremely important part of our work because we are required to make decisions quickly with little information,” says Jeffrey A. Kline, an emergency physician at Wayne State University School of Medicine in Detroit. “Intuition is an important factor in deciding whether to order diagnostic tests, particularly imaging studies. »
A study published in the journal Plus one supports the view of Jeffrey A. Kline. This showed that nurses’ and physicians’ clinical intuition was highly accurate about the likelihood that elderly patients admitted to the emergency department would die within 30 days or suffer other adverse outcomes. Additionally, when patients agreed with the doctor’s intuitive judgment, their chances of an accurate diagnosis increased. Additionally, research suggests that patients’ intuitions about what is wrong with them is useful information for primary care physicians to consider when making treatment decisions.
In late November, Keith Siau had a breakthrough in clinical intuition that went viral on X (formerly Twitter). As a gastroenterologist at the Royal Cornwall Hospitals in the United Kingdom, he received a call from an experienced colleague who was treating an 80-year-old man who was suffering from jaundice due to a large gallstone lodged in the lower part of his bile duct (a medical condition). known as cholangitis). He had been in the hospital for five days and his condition was stable, his blood counts were normal and so were his blood counts. The patient also had a blood clot in the lung and was receiving short-term anticoagulant treatment.
The dilemma was: Should one do an endoscopy immediately as a temporary solution (to treat the blocked bile duct) and risk excessive bleeding, or should one wait a day for the body to eliminate the anticoagulant, which would allow the clot to be completely removed? Keith Siau thought it prudent to wait to remove the clot with one procedure instead of two. The other doctor reluctantly agreed.
“As I hung up, I realized I had ignored this senior colleague’s intuition that something was wrong with this patient,” says Keith Siau. So he called his colleague back and asked if he thought the patient’s condition would worsen if he waited another day. His colleague replied Ouiand the patient was taken to the operating room.
By the time he arrived in the operating room, his heart rate had increased to 180-200 beats per minute and his temperature had skyrocketed. After the patient gave consent, Keith Siau carefully performed the endoscopy and placed a stent to drain pus and bile. “When I visited him the next day he was a different person, his fever had gone and he looked much better – and felt much better too,” he said. For me, the moral of the story is to trust the sixth sense that other experienced clinicians have. I was lucky that day because if we had been late the outcome could have been completely different. »
None of these experiments suggest that clinical intuition should be blindly followed by action. Making clinical decisions based solely on a doctor’s intuition is not the way to go, experts say. But relying solely on medical algorithms (mathematical models) that generate predictions about how a patient is likely to respond to various treatments is also not the best way forward.
“What makes big data experts uncomfortable is the wide variability in a given doctor’s clinical intuition, whether because they are tired, less experienced, distracted, or for other reasons,” adds Gabriel Brat. That’s why we don’t use it alone. It’s really important that we ask ourselves when this intuition has value. »
To optimize patient care, some experts believe a hybrid approach that combines clinical intuition, predictive algorithms, patient preferences and other key factors is critical. “Clinical intuition is part of clinical expertise,” says Jennifer Yost, a pediatric critical care nurse and professor at the M. Louise Fitzpatrick School of Nursing at Villanova University. “We make poor healthcare decisions when clinical expertise is the only factor that comes into play. »
According to some experts, health professionals should know how to recognize the moments when they are intuitive and listen to them. Next, they should weigh their intuition and objective information (constants, test results), and then reason analytically to decide what course of action to take. According to Mohammed Ghassemi, it is also important for clinicians to compare their intuitions with those of other health professionals to see if they match.
“As doctors, we all want to see ourselves as purely rational actors who integrate data and make decisions on this basis,” complains Gabriel Brat. It is clear for several reasons that doctors make decisions based not on algorithms but on intuition. I believe that collaboration between artificial intelligence tools and clinical intuition will be the best approach in the future as it has a good chance of leading to the best outcomes for patients. »
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