Clinical intuition in family medicine: more than first impressions

PURPOSE The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician’s mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine.

METHOD Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) partici- pants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judg- ments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types.

RESULTS Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ=0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do.

CONCLUSION Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the dif- ferent types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed.