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Role of intuitive knowledge in the diagnostic reasoning of hospital specialists: a focus group study
  1. Nydia Van den Brink1,
  2. Birgit Holbrechts1,
  3. Paul L P Brand2,
  4. Erik C F Stolper1,3,
  5. Paul Van Royen3
  1. 1 Faculty of Medicine and Health Sciences, Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
  2. 2 Department of Pediatrics, Isala Hospitals, Zwolle, The Netherlands
  3. 3 CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
  1. Correspondence to Dr Erik C F Stolper; cf.stolper{at}maastrichtuniversity.nl

Abstract

Background and objective Intuition is an important part of human decision-making and can be explained by the dual-process theory where analytical and non-analytical reasoning processes continually interact. These processes can also be identified in physicians’ diagnostic reasoning. The valuable role of intuition, including gut feelings, has been shown among general practitioners and nurses, but less is known about its role among hospital specialists. This study focused on the diagnostic reasoning of hospital specialists, how they value, experience and use intuition.

Design and participants Twenty-eight hospital specialists in the Netherlands and Belgium participated in six focus groups. The discussions were recorded, transcribed verbatim and thematically coded. A circular and iterative analysis was applied until data saturation was achieved.

Results Despite initial reservations regarding the term intuition, all participants agreed that intuition plays an important role in their diagnostic reasoning process. Many agreed that intuition could guide them, but were cautious not to be misguided. They were especially cautious since intuition does not have probative force, for example, in medicolegal situations. ‘On-the-job experience’ was regarded as a precondition to relying on intuition. Some participants viewed intuition as non-rational and invalid. All participants said that intuitive hunches must be followed by analytical reasoning. Cultural differences were not found. Both the doctor as a person and his/her specialty were seen as important determinants for using intuition.

Conclusions Hospital specialists use intuitive elements in their diagnostic reasoning, in line with general human decision-making models. Nevertheless, they appear to disagree more on its role and value than previous research has shown among general practitioners. A better understanding of how to take advantage of intuition, while avoiding pitfalls, and how to develop ‘skilled’ intuition may improve the quality of hospital specialists’ diagnostic reasoning.

  • clinical reasoning
  • hospital specialists
  • decision making
  • intuition

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Patient consent for publication Not required.

  • Contributors NVdB: collecting of the data, analysis, drafting the manuscript, final approval. BH: collecting of the data, analysis, drafting the manuscript, final approval. PLPB: collecting of the data, analysis, drafting the manuscript, final approval. ECFS: conducting the study design, collecting of the data, analysis, drafting the manuscript, final approval. PVR: conducting the study design, analysis, drafting the manuscript, final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data—the six transcripts, the code book and the results of the thematic analysis—are available for sharing via the corresponding author.

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