Doctors are told to think rationally to avoid errors

25 November 2010

An overreliance on intuitive decision-making in clinical diagnosis can lead to errors, according to an expert speaking at a recent patient safety conference hosted by Great Ormond Street Hospital in London.

Psychologist and professor in emergency medicine Pat Croskerry said that doctors were too quick to base their clinical decisions on intuition rather than on rational analysis.

Professor Croskerry, from Dalhousie University in Halifax, Nova Scotia, said: "Our intuition will always override analytical reasoning. We prefer to be in the intuitive mode; it is comfortably numb, but it gives you a misplaced feeling of security."

"Most doctors work under time pressures, and it is very appealing to act on the fact that 'my gut is telling me something.'… Our intuitions mostly serve us well, but they are occasionally catastrophic."

He cited the example of a 54-year-old man complaining of abdominal pain that he thought was due to constipation. "That particular clinic had been going full out, all day long, and this guy comes in at the last minute and says he’s been constipated for four days and has tried various different laxatives," said Professor Croskerry. The doctor prescribed a more powerful laxative but the patient later collapsed and died of a ruptured abdominal aorta.

"The patient had diagnosed himself with constipation, and the doctor had just agreed. The doctor didn’t ask analytical questions. The trick for a well calibrated physician is to say, ‘It looks like this but what else could it be?'"

Professor Croskerry has called on medical schools to ensure students are aware of the difference between intuitive and rational thinking.

He said: "Our first response is an intuitive response, and you have to suppress that sometimes, especially in medicine."

Source: BMJ