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Steps Description Step 1 The participant defines the scope of the event, ie, whether it took place during a single consultation or over multiple consultations. The scope is refined, if necessary, by the interviewer to cover only the participant’s involvement. For example, details of patients’ secondary care and outcome or related consultations with other family physicians were noted but not probed Step 2 The interviewer repeats back the account to be updated or corrected until a shared understanding of the episode is reached Step 3 A timeline of events is drawn on paper to aid accurate elicitation of decision information, paying attention to when new information was received and when key decisions were made Step 4 Using the timeline, the interviewer probes the account for more detail at points of new information, judgments, decisions, and reasoning processes. In this way, the implicit information and processes that were active during the episode are elicited Step 5 Hypothetical questions are asked to identify the implicit cues critical to intuitive decisions, for example, “What if the blood results were normal? How would that change your appraisal?” Criteria Description Judgments The point of making a judgment, appraisal, current hypotheses, or working diagnosis Cues All perceptual and verbal information available explicitly and elicited implicit cues, including symptoms, signs, and context. Information learned after the episode, therefore not associated with a judgment point, was not coded Expectancies Participants’ mental representations of the relationships between cues and judgments. Includes both deliberative and elicited implicit reasoning Goals The participants indicated aim at each point of judgment, or explanation for an action Action Actions taken, ie, details of history taking, examination, referral, etc
Additional Files
Supplemental Appendix
Supplemental Appendix. Case Examples of the 3 Decision Process Types
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file, 3 pages, 176 KB
The Article in Brief
Clinical Intuition in Family Medicine: More Than First Impressions
Amanda Woolley and Olga Kostopoulou
Background Clinical intuition is sometimes viewed as the mark of an expert and other times as mere guesswork. This study examines intuition as experienced by physicians and identifies the cognitive processes active in medical decision making.
What This Study Found Although the medical literature discusses clinical intuition as first impressions or the first thing that comes to a physician's mind, this is only a part of what most family physicians understand by the term "intuition." Based on in-depth interviews with 18 family physicians analyzing 24 different patient cases in which the physicians believed they experienced an intuition, 3 types of decision processes emerged: gut feelings, recognitions, and insights. In all cases examined, participants experienced conflict between their intuition and a decision they perceived to be more rational or between their intuition and their expectations about what other physicians would do.
Implications
- The outcomes of clinical intuition can be negative or positive.
- The authors suggest that, until we know more about the circumstances under which intuitive processes produce accurate judgments, physicians should not be directed to avoid intuition.
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