Greenhalgh Trisha
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London.
Br J Gen Pract. 2002 May;52(478):395-400.
Intuition is a decision-making method that is used unconsciously by experienced practitioners but is inaccessible to the novice. It is rapid, subtle, contextual, and does not follow simple, cause-and-effect logic. Evidence-based medicine offers exciting opportunities_for improving patient outcomes, but the 'evidence-burdened' approach of the inexperienced, protocol-driven clinician is well documented Intuition is not unscientific. It is a highly creative process, fundamental to hypothesis generation in science. The experienced practitioner should generate and follow clinical hunches as well as (not instead of applying the deductive principles of evidence-based medicine. The educational research literature suggests that we can improve our intuitive powers through systematic critical reflection about intuitive judgements--for example, through creative writing and dialogue with professional colleagues. It is time to revive and celebrate clinical storytelling as a method for professional education and development. The stage is surely set for a new, improved--and, indeed, evidence-based--'Balint'group.
直觉是一种决策方法，经验丰富的从业者会在无意识中使用它，但新手却无法掌握。它快速、微妙、依赖情境，且不遵循简单的因果逻辑。循证医学为改善患者治疗效果提供了令人兴奋的机会，但缺乏经验、受协议驱动的临床医生那种“证据负担过重”的方法已被充分记录。直觉并非不科学。它是一个高度创造性的过程，是科学中假设生成的基础。经验丰富的从业者应该产生并遵循临床直觉，同时（而不是取代）应用循证医学的演绎原则。教育研究文献表明，我们可以通过对直觉判断进行系统的批判性反思来提高我们的直觉能力——例如，通过创造性写作和与专业同事对话。现在是时候复兴并推崇临床叙事，将其作为专业教育和发展的一种方法了。无疑，一个全新的、改进的——而且确实是循证的——“巴林特”小组已呼之欲出。
