Vanstone Meredith, Monteiro Sandra, Colvin Eamon, Norman Geoff, Sherbino Jonathan, Sibbald Matthew, Dore Kelly, Peters Amanda
Department of Family Medicine, McMaster University, DBHSC 5003E 100 Main St W, Hamilton, ON L8P 1H6, Canada.
McMaster Faculty of Health Sciences Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, ON, Canada.
Diagnosis (Berl). 2019 Aug 27;6(3):259-268. doi: 10.1515/dx-2018-0069.
Background Diagnostic intuition is a rapid, non-analytic, unconscious mode of reasoning. A small body of evidence points to the ubiquity of intuition, and its usefulness in generating diagnostic hypotheses and ascertaining severity of illness. Little is known about how experienced physicians understand this phenomenon, and how they work with it in clinical practice. Methods Descriptions of how experienced physicians perceive their use of diagnostic intuition in clinical practice were elicited through interviews conducted with 30 physicians in emergency, internal and family medicine. Each participant was asked to share stories of diagnostic intuition, including times when intuition was both correct and incorrect. Multiple coders conducted descriptive analysis to analyze the salient aspects of these stories. Results Physicians provided descriptions of what diagnostic intuition is, when it occurs and what type of activity it prompts. From stories of correct intuition, a typology of four different types of intuition was identified: Sick/Not Sick, Something Not Right, Frame-shifting and Abduction. Most physician accounts of diagnostic intuition linked this phenomenon to non-analytic reasoning and emphasized the importance of experience in developing a trustworthy sense of intuition that can be used to effectively engage analytic reasoning to evaluate clinical evidence. Conclusions The participants recounted myriad stories of diagnostic intuition that alerted them to unusual diagnoses, previous diagnostic error or deleterious trajectories. While this qualitative study can offer no conclusions about the representativeness of these stories, it suggests that physicians perceive clinical intuition as beneficial for correcting and advancing diagnoses of both common and rare conditions.
诊断直觉是一种快速、非分析性的无意识推理模式。少量证据表明直觉无处不在，且在生成诊断假设和确定疾病严重程度方面有用。对于经验丰富的医生如何理解这一现象以及他们在临床实践中如何运用它，我们知之甚少。
通过对30名急诊、内科和家庭医学医生进行访谈，引出他们对在临床实践中如何运用诊断直觉的描述。要求每位参与者分享诊断直觉的故事，包括直觉正确和错误的情况。多名编码员进行描述性分析，以分析这些故事的显著方面。
医生们描述了诊断直觉是什么、何时出现以及它会引发何种类型的活动。从正确直觉的故事中，识别出四种不同类型直觉的分类：患病/未患病、感觉不对劲、框架转换和溯因。大多数医生对诊断直觉的描述将这一现象与非分析性推理联系起来，并强调经验在培养可用于有效运用分析性推理来评估临床证据的可靠直觉感方面的重要性。
参与者讲述了无数关于诊断直觉的故事，这些直觉使他们警觉到异常诊断、先前的诊断错误或有害的病程。虽然这项定性研究无法就这些故事的代表性得出结论，但它表明医生认为临床直觉有助于纠正和推进对常见和罕见病症的诊断。
