Abstract
ABSTRACT Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of ‘emergency’ (necessity of making instantaneous decisions in unforeseeable situations) and ‘complexity’ (necessity of considering multiple perceptual and diagnostic aspects of patients’ health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of ‘high likelihood of emergency’ or ‘high complexity’ increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs’ propensity for IDM. Additionally, we performed content analysis of participants’ free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs’ propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.
Highlights
The use of intuition in clinical decision-making (CDM) has been the object of a long standing debate
We propose a two-way classification in terms of ‘likelihood of emergency’ and ‘complexity’, two dimensions supposedly influencing the extent to which medical specialties are conducive to intuitive decision-making (IDM)
Out of the 229 case descriptions submitted by 667 health care practitioners’ (HCPs) in the unrestricted sample, we identified 140 as containing important characteristics of intuitive information-processing and/or intuitive decision-making
Summary
The use of intuition in clinical decision-making (CDM) has been the object of a long standing debate. Several authors have pointed out that the benefits of intuition as a mode of human cognition lie in its capacity to transcend the boundaries of analytical thinking as for the maximal complexity of problems that can be formulated and solved in an efficient way (Dreyfus & Dreyfus, 1986; Hogarth, 2005; Mero, 2002) Having proposed these two dimensions, one of our objectives was to establish an empirical classification of medical specialties in terms of ‘complexity’ and ‘likelihood of emergency’ and confirm our hypotheses about how they relate to the prevalence of IDM. We formulated the following hypotheses about some of the possible factors of IDM in medicine. (1) HCPs’ propensity for IDM increases with professional experience. (2) Higher responsibility health care occupations (physician) are more conducive to IDM than lower responsibility occupations (nurse). (3) The more extensive education a HCP has received in the topic of IDM, the more likely he/she will use it in his/her practice. (4) HCPs occupied in specialties of high likelihood of emergency have a greater propensity for IDM than those occupied in specialties of lower likelihood of emergency. (5) HCPs occupied in specialties of high complexity have a greater propensity for IDM than those occupied in specialties of lower complexity
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