A Call for Intuitive Medicine

I recently finished reading a review copy of the soon-to-be-released book Gut Feelings: The Intelligence of the Unconscious by German psychologist Gerd Gigerenzer. The book -- which is fascinating -- argues that intuition is a powerful tool that we all too often wave aside in favor of reason (Gigerenzer's research informed some of Malcolm Gladwell's bestselling book Blink).

One of the book's chapters is titled "Less is More in Health Care," and it presents a thought-provoking analysis of some of the problems Gigerenzer feels exist today in medicine -- and what doctors and patients can do to help "fix" them.

Doctors, Gigerenzer asserts, are so worried about being sued that they frequently over-diagnose and over-treat their patients. Fear of lawsuits and aggressive direct-to-consumer advertising "lead to a decrease in the quality and an increase in the costs of health care," he writes. He goes on to describe a lecture he gave to a group of 60 physicians in which they discussed breast cancer screening (mammograms). Over three-quarters of American women over 50 get regular mammograms, but not a single female doctor in the room said that she got screened, and none of the male physicians said they would do so if they were women. This is but one example of the vast gap that exists between what doctors recommend for their patients (out of fear) and what they would actually do for themselves or members of their own family (e.g., the best treatment).

The practice of medicine, Gigerenzer says, can be improved by setting up simple, empirically-informed rules that doctors can follow to set them free from some of these pressures. These rules can be so simple as to be counter-intuitive -- throughout the book, Gigerenzer argues that decisions based on less information can often be more accurate than those based on more. Gladwell, on his website, describes a pertinent example:

"One of the stories I tell in Blink is about the Emergency Room doctors at Cook County Hospital in Chicago. That's the big public hospital in Chicago, and a few years ago they changed the way they diagnosed heart attacks. They instructed their doctors to gather less information on their patients: they encouraged them to zero in on just a few critical pieces of information about patients suffering from chest pain--like blood pressure and the ECG--while ignoring everything else, like the patient's age and weight and medical history. And what happened? Cook County is now one of the best places in the United States at diagnosing chest pain.

Not surprisingly, it was really hard to convince the physicians at Cook County to go along with the plan, because, like all of us, they were committed to the idea that more information is always better. But I describe lots of cases in Blink where that simply isn't true. There's a wonderful phrase in psychology--'the power of thin slicing'--which says that as human beings we are capable of making sense of situations based on the thinnest slice of experience. I have an entire chapter in Blink on how unbelievably powerful our thin-slicing skills are. I have to say that I still find some of the examples in that chapter hard to believe."

Following simple rules like the one Gladwell describes can reduce overcrowding in hospitals, increase quality of care, and make treatment choices similar across-the-board, Gigerenzer writes.

Until that happens, he suggests that patients follow some simple advice. When asking for your doctors' treatment recommendations, ask them not what they would recommend for you, but what they would recommend for their family members. Often that's all you need to do to ensure you get the best, most sensical treatment.