Expository Essay

Analysis + Intuition = ?

The November 2006 British Medical Journal reported that Google, a search engine, can give a correct diagnosis of a condition given three symptoms 58% of the time (Woolever). Doctor’s clinical decision making has received ample attention over the past two years. A book released three years ago, How Doctors’ Think, brought up the debate between how valuable doctors are for the decision making process in the health-care system. From then on, efforts have been made by many administrators to determine how much should be through an analytical protocol system and how much through the intuition and training of medical staff. Going deeper, discussion has even sprung up about how protocol should be structured and whether outside resources are necessary or unwanted. It is time to explore if there is a middle ground, and, if there is, if it is the best direction to take medical care.

In Malcolm Gladwell’s book, blink, he explores how different amounts of information affect the decision-making process. While he discusses these ideas relating to more than medicine, he does linger on how protocol took effect at Cook County Hospital in the late 1990s. In an attempt to save money, Cook County Hospital implemented a new form of diagnosing heart attacks. Instead of doctors making a complete judgement call based on all of the information they could gather, a three question process was put into place. This decision tree, Gladwell says, “was a whopping 70 percent better than the old method at recognizing the patients who weren’t actually having a heart attack” (Gladwell, 135). Cook County Hospital switched methods in an instant. The take away from the switch is that society’s normal view is that decision-makers should gather all the possible information they can to make an educated, rational decision. However, Gladwell advocates for the fact that, “extra information is more than useless. It’s harmful. It confuses the issues. What screws up doctors when they are trying to predict heart attacks is that they take too much information into account” (Gladwell, 137). Leaving judgement calls to only doctor’s intuition and thoughts can often hurt their ability to make a correct decision. The decision tree, a form of protocol, gave the doctors a way to monitor themselves and how much information they really needed to make a health care decision.

There is intense pushback from implementing protocols across medical care, and often with good reason. People want to treat doctors as, “intelligent human being who [are] capable of exercising good medical judgment” (Clawson). Current protocol documents define that, “EMDs should follow a structured, predetermined interrogation process to activate preprogrammed response modes and provide medical instructions to callers prior to EMS arrival” (Clawson). This undermines doctor’s judgement calls and makes them feel like talentless rule-followers. Gladwell, again referencing Cook County Hospital, says, “Doctors think it’s mundane to follow guidelines… it’s much more gratifying to come up with a decision on your own” (Gladwell, 139). The average doctor goes to four years of undergraduate school, four years of medical school, and three years of residency. Doctors want to believe that their expensive, extensive education was worth something more than being able to follow a handbook. They remark, “Anyone can follow an algorithm” (Gladwell, 139).

There is a heavily supported middle ground, guidelines. While there is a big contingent that claims protocol and intuition create a zero-sum equation--having more of one results in less of the other--the general public calls that a “false dichotomy” (Greenhalgh). Advocates of guidelines claim that it gives doctors the respect they deserve while maintaining structure that gives doctors a reliable starting place (Clawson). Along with the more flexible guidelines comes education tools to support them. Specifically, critical reflection on past intuition driven assessments highlights, “areas of ambiguity in complex decision-making, sharpens perceptual awareness, exposes the role of emotions in driving ‘hunches’” (Greenhalgh). Taking the time to fine tune the use of intuition in medical care is a necessary responsibility. Rising technology has played a big role in the attempt “to integrate the ‘science’ of evidence-based medicine with the intuitive ‘art’ of clinical judgement” (Greenhalgh). Online diagnostic tools have become commonplace and allow doctors to save time and effort. Support for guidelines in rising, and the use of technology in conjunction with classic medical training has begun to be commonplace.

The underlying theme throughout this discussion is that medical care is a balancing act between “art and science, intuition and analysis, gut instinct and evidence, experience and knowledge” (Woolever). A final piece of advice spread throughout teaching facilities is to formalize a personal approach to diagnosis and treatment that lies between protocol and intuition. Defining a consistent, individual decision-making process will lead lead to more confident, and more accurate, clinical decisions. Doctors should be given freedom to their academic success to work, but have a system in place to structure their work to gain the best results possible.

Bibliography

Clawson, Jeff J., Robert L. Martin, and Scott A. Hauert. "Protocols vs. Guidelines: Choosing a
Medical-Dispatch Program." Protocols vs. Guidelines: Choosing a Medical-Dispatch Program. Emergency Medical Services, Oct. 1994. Web. 19 May 2015.

Gladwell, Malcolm. Blink: The Power of Thinking without Thinking. New York: Little, Brown, 2005. Print.

Greenhalgh, Trisha. "Intuition and Evidence — Uneasy Bedfellows?" British Journal of General
Practice (2002): n. pag. May 2002. Web. 19 May 2015.

Woolever, Donald R. "The Art and Science of Clinical Decision Making."Family Practice
Management. AAFP, 15 May 2008. Web. 19 May 2015.