Gut Feelings as a Third Track in General Practitioners’ Diagnostic Reasoning

BACKGROUND: General practitioners (GPs) are often faced with complicated, vague problems in situations of uncertainty that they have to solve at short notice. In such situations, gut feelings seem to play a substantial role in their diagnostic process. Qualitative research distinguished a sense of alarm and a sense of reassurance. However, not every GP trusted their gut feelings, since a scientific explanation is lacking. OBJECTIVE: This paper explains how gut feelings arise and function in GPs' diagnostic reasoning. APPROACH: The paper reviews literature from medical, psychological and neuroscientific perspectives. CONCLUSIONS: Gut feelings in general practice are based on the interaction between patient information and a GP's knowledge and experience. This is visualized in a knowledge-based model of GPs' diagnostic reasoning emphasizing that this complex task combines analytical and non-analytical cognitive processes. The model integrates the two well-known diagnostic reasoning tracks of medical decision-making and medical problem-solving, and adds gut feelings as a third track. Analytical and non-analytical diagnostic reasoning interacts continuously, and GPs use elements of all three tracks, depending on the task and the situation. In this dual process theory, gut feelings emerge as a consequence of non-analytical processing of the available information and knowledge, either reassuring GPs or alerting them that something is wrong and action is required. The role of affect as a heuristic within the physician's knowledge network explains how gut feelings may help GPs to navigate in a mostly efficient way in the often complex and uncertain diagnostic situations of general practice. Emotion research and neuroscientific data support the unmistakable role of affect in the process of making decisions and explain the bodily sensation of gut feelings.The implications for health care practice and medical education are discussed

Concepts without intuition lose the game: commentary on Montero and Evans (2011)

In several papers, Hubert Dreyfus has used chess as a paradigmatic example of how experts act intuitively, rarely using deliberation when selecting actions, while individuals that are only competent rely on analytic and deliberative thought. By contrast, Montero and Evans (Phenomenology and the Cognitive Sciences 10:175-194, 2011) argue that intuitive aspects of chess are actually rational, in the sense that actions can be justified. In this paper, I show that both Dreyfus's and Montero and Evans's views are too extreme, and that expertise in chess, and presumably in other domains, depends on a combination of intuitive thinking and deliberative search, both mediated by perceptual processes. There is more to expertise than just rational thought. I further contend that both sides ignore emotions, which are important in acquiring and maintaining expertise. Finally, I argue that experimental data and first-person data, which are sometimes presented as irreconcilable in the phenomenology literature, actually lead to similar conclusions