How Deliciously Unscientific!
Modern Medicine Embraces Intuition
SOURCE: MedPage Today ~ Sept. 25, 2012
By Nancy Walsh, Staff Writer
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston
‘Gut Feelings’ Matter in Diagnosis of Kids’ Infections
This new MedPage review advises medical doctors that: Physicians should pay attention to their “gut feeling” that something may be seriously wrong when assessing a child with an infectious disease — even if the clinical appearance is reassuring.
Among 3,369 children whose primary care evaluation did not suggest a serious illness, six (0.2%) ultimately were admitted to the hospital with a severe infection, according to Ann Van den Bruel, MD, PhD, of the Radcliffe Observatory Quarter in Oxford, England, and colleagues.
The clinician’s gut feeling that the child was seriously ill considerably increased the chance that a severe infection was present, with a likelihood ratio of 25.5 (95% CI 7.9 to 82), and heeding the feeling might have prevented two cases from being overlooked (33%, 95% CI 0.95 to 1.75), the researchers reported online in BMJ.
Considerable research has focused on developing tools for clinical prediction in acutely ill children, including symptoms, vital signs, and laboratory tests, but primary care physicians often see children before the full clinical picture has developed — and sometimes report relying on intuition that a potentially serious problem exists even though they’re unsure why.
Moreover, a systematic review recently determined that such a gut feeling had considerable diagnostic significance. 
The most remarkable findings in this study were:
They advised that medical training should emphasize the potential value of gut feelings, and suggested that any such feelings should warrant a “full and careful” examination, consulting with other more experienced clinicians or referral, and explanations to the parent of their need to observe the child diligently.
My response? I say BRAVO to these authors!!! As medicine descends further into algorithm-driven clinical prediction rules and care pathways, patients become dehumanized constellations of signs and symptoms, and healthcare devolves into a multiple-choice quiz.
Encouraging students and doctors to remain (or become) sensitive to their own intuition is a daring step into the scientific unknown. By the author’s own statistics, taking that extra intuitive step only helped 0.2% of their patients, but…wouldn’t you be happy if that was your child?
- Explain that an observational study found that the “gut feeling” of a physician that a child’s illness might be more serious than it appeared had a low sensitivity but high specificity for infections that required hospitalization.
- Note that physician reports of these gut feelings decreased 5% per year in practice.
1. Clinicians’ Gut Feeling About Serious Infections in Children: Observational Study
British Medical Journal 2012 (Sep 25); 345: e6144 ~ FULL TEXT