How good is your intuition?

Steve Simon


One definition of Evidence Based Medicine is

the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett et al 1996.

In the same article, the authors point out that

Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.

A recently published book by Malcolm Gladwell highlights the value of individual expertise, which you might also call clinical judgment or simply intuition.

The author describes his book

It’s a book about rapid cognition, about the kind of thinking that happens in a blink of an eye. When you meet someone for the first time, or walk into a house you are thinking of buying, or read the first few sentences of a book, your mind takes about two seconds to jump to a series of conclusions. Well, “Blink” is a book about those two seconds, because I think those instant conclusions that we reach are really powerful and really important and, occasionally, really good. You could also say that it’s a book about intuition, except that I don’t like that word. In fact it never appears in “Blink.” Intuition strikes me as a concept we use to describe emotional reactions, gut feelings--thoughts and impressions that don’t' seem entirely rational. But I think that what goes on in that first two seconds is perfectly rational. It’s thinking--its just thinking that moves a little faster and operates a little more mysteriously than the kind of deliberate, conscious decision-making that we usually associate with “thinking.” In “Blink” I’m trying to understand those two seconds. What is going on in inside our heads when we engage in rapid cognition? When are snap judgments good and when are they not? What kinds of things can we do to make our powers of rapid cognition better?

I have not yet read the book, but it sounds like a good counterpoint to the belief that a careful, thoughtful, rational analysis is always best.

Here are some of the references that suggest the opposite viewpoint, that intuition is not as good as a careful analysis. Some of these I have read, and others were recommended to me just recently.

I’d like to write up a few examples of how our intuition often fails us, especially when we really on anecdotal evidence. I touch on this briefly in my speech, Is the randomized trial the gold standard for research?.

You can find an earlier version of this page on my original website.