Can intuition be taught? - what is intuition then? (spell correction)

pb mikburger22 at YAHOO.COM
Tue Aug 20 03:55:27 UTC 2013


  


 
Hello
 
Ive been watching this from the sidelines.   It has been interesting.
 
Im a 30+ year ER/UC doc - trained in Int Med.    Im an Associate Prof at the Univ of MN
and have taught students since 87"
 
Before I make my point a useful joke -
 
An older patient comes in with crushing chest pain.    He is sweaty and out of breath.
Five minutes later he arrests and can not be resuscitated.
 
At morning rounds the attending asks what the autopsy showed.    The Fellow says it showed
a large heart attack due to coronary disease.   Nope says the attending.   The Resident 
says it showed  Pulmonary Embolism  as the fellow had awful chest pain and died suddenly.
 Nope again.   The Intern said a dissection was likely.   Probably tore through the aorta and 
ruptured.   Nope again.
 
Finally the medical student was asked.   He looked sheepish but said he thought it was probably 
a case of a dog worm, Angiostrongylus vasorum, crossing species and eating through
the poor man's heart."
 
The attending looked astonished as he nodded his head yes.   The others as well.   "How did you
know,"  asked the Fellow.    
 
"Well",  said the student,  "what else could cause chest pain?"
 
Here is my two cents worth -
 
Learning how to simplify and move toward that which matters can be taught - and can look like intuition.  In an ER setting one can "learn" this form of intuition.   But basically what one learns is to follow a simple precept, make sure you dont walk by that which will cause immense harm if missed.    Learning how to "cut to the chase" in the ER setting usually means find the bad problems,turf the rest.   Reassure when needed, use placebos when needed, but dont miss the baddies.   This then is "ER intuition."  
 
"Intuition" can have more complex meanings.   It can mean when something isnt acting like the "Horse,"  opening up to thinking about the Zebras and about labs that might have been wrong, or xrays that may have been misread, or slides that may not have been interpreted correctly.   
 
Intuition can mean thinkingabout how one's mind set, or prejudices, or pride might be getting in the way.
Or how last night's poor sleep, a look by the patient's "wife", or a previous similar case which 
went badly might be affecting your analysis.   It can mean becoming aware of how the environment
might be distracting you and misleading you in many ways.
 
The most important "intuition"  is that which allows one to "intuit"  there are a multitude of both
internal and external issues which can get in the way of properly helping the patient.    Once you 
"grok" this you have a chance to move past some of those aspects of clinical care which cause
the biggest problems with proper care and diagnosis.
 
Paul Bearmon 







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