Table 2


Description intuition
1.1NL 2We all have this, if we first meet a patient, those first couple of seconds that you see somebody, you get a feeling of whether the situation is serious or not, alarming or not.
1.2NL 2Yes, when you mention intuitive thinking I obviously immediately think about my professional domain and about gut feeling.
1.3NL 3For me the word intuition is more… erm… something that doesn’t rely on knowledge or experience, but more a sort of feeling, and to me what you’re referring to, and what I mean, is not a feeling but pattern recognition.
Relying on intuition
2.1NL 1Well, at a certain moment you feel this is what it is, more or less, and that’s a feeling I have very strongly with patients and //at the hospital I rely on my feelings… well… for about 80%.
2.2BE 3I also distrust it. I do use it, but I also distrust it, right?
2.3NL 3Some of us in the group are very allergic to the word gut feelings. They think that as a doctor you can’t use that term. But at the same time, I think that everyone knows that it does exist.
2.4BE 2It offers a certain advantage I think. You argue more correctly if you also use that intuition.
2.5NL 2Yes, I don’t experience a discrepancy either between the initial gut feeling, or whatever you want to call it, and what comes out in the end.
2.6BE 2I actually agree with what you say about the initial thought being biased, that gut feeling, by what you know before the patient enters, by what you saw in C2M (electronic medical record), by what the secretary has said when introducing the patient, by what you might have heard from the GP on the phone. So, you often get a biased picture.
2.7BE 2Then you tell yourself I can skip that clinical examination, because last time nothing came out.
Intuition in the process of diagnostic reasoning
 Presentation of intuition
3.1BE 2Even if you just hear a story from an assistant //Then the first thing is that there is something in in your guts, something that says this is alarming or reassuring. And then you listen very critically, to the whole story… By also building up a systemic picture.
 Triggers of intuition
3.2BE 2But well, observations are always partly intuitive, aren’t they? You first look at what is going on with the person in front of you. What he’s saying. I think it’s like that in all specialities. You don’t immediately work systematically.
3.3BE 1There’s a lot more involved then. What does the patient look like? At that moment it’s a kind of multisensory experience. What does the patient look like? How is his breathing, and you listen to that for a while. Yes, there’s a lot more to it than listening to their story on the phone. On the phone, it’s purely factual, based on a number of questions. If you can actually see the patient, it’s totally different.
 Intuition provides guidance
3.4NL 2But the intuition helps you, gives you guidance.
3.5NL 1That’s how I’ve spared a hundred children some complicated investigation.
 NAR is followed by AR
3.6BE 3I often find it an important tool at the start, but it’s never going to be the only factor in the eventual conclusion and the eventual decision on the diagnosis and therapy for the patient.
 Interaction and balance between NAR and AR
3.7BE 2You have to find the balance between intuition and systematic approach.
3.8BE 3I think it’s obvious that at busy moments, simply because there’s no other option, you sometimes have to rely on gut feelings. Even if it’s only because you don’t have time for analytical reasoning.
3.9BE 3But I’m convinced that experienced emergency specialists regularly rely on their gut feelings, to make a quick first assessment of the degree of urgency. Maybe even more than in other disciplines.
Determinants of intuition
4.1NL 2Because intuition is made up of experience and knowledge.
4.2BE 2I think some doctors who are less able to rely on that experience, on that intuition, they have to fall back on systematics. And so as you gain more experience, you can let go of that to some extent.
Differences and similarities between specialities
5.1NL 1I always think, cardiology is of course a very different discipline, because we have, I believe, something like ten illness scripts, yes and I just check them all. Could it be this, or that? And we can actually image everything, so we can often figure it out.
5.2BE 2Subjectivity plays an important part, so you automatically start to make more use of the intuitive. (a psychiatrist)
5.3BE 3No, but general practitioners also need to deal with a different form of uncertainty, and are not held to account for that, the way it happens at a hospital. GPs are able to work with uncertainties. And that’s a lot more difficult for a hospital doctor.
5.4BE 3A necessary condition for using intuition is, for example, empathy. So the better you’re able to understand what the patient means or feels, the better of course you can assess the situation //There are people who are simply purely scientifically oriented and have no empathic ability. Those are people who are less likely to develop this kind of intuition, or they develop it in a less valuable way.
Defensive medicine
6.1BE 2That [I’ve made this decision based on my intuition] is not something you can say before a court, right?
6.2BE 3And of course in situations where you don’t yet have the experience, you’ll need to rely on the evidence to some extent, and after you have gained the experience, you still have to keep looking at the evidence from the literature, and maintain a balance between the two.
Medical education
7.1NL1Yes, that’s exactly when you have to check, I think always, or occasionally, why do I get this feeling, right? And that’s what’s so good about a hospital like this, that there is a trainee doctor sitting beside you. And when you tell them it’s this or that, you need to explain why you get that feeling.
7.2BE 1It should encourage you to recognise that feeling that arises and then to think right, I need to do something about this, in the sense of further reflection or especially thinking why do I get this feeling with this particular patient? //In my case, that often induces me to broaden my scope or to discuss it with someone else or consult another book…
7.3BE 2When trainees see patients they get feedback on their findings. I think that’s very important. Also with regard to this intuitive thinking. But I think, erm, what you could also do in their training is emphasise its value more.
  • AR, analytical reasoning; BE, Belgium; GP, general practitioner; NAR, non-analytical reasoning; NL, Netherlands.