Lord Darzi’s observation that questioning and challenge are essential
in any health care system is undeniably true. The argument he quotes that
‘medicine continues to move dramatically from an intuitive level to an
empirical (and eventually precise) one’ demands both questioning and
challenge.
The bold thinking which he rightly says is necessary needs not just
empiricism, but imagination and pragmatism. Empiricism gives us facts. In
the practice of medicine, the facts rarely give a simple way forward, and
making a good clinical decision often demands interpretation based on all
the contingencies of the situation, which include the values of all
concerned , and the resources available to deal with the problem (1).
Precision is welcome but often elusive. Intuition is often needed to make
a decision in the face of uncertainty (2). To suggest that we should be
abandoning intuition as we move an empirical utopia is to do our patients,
the profession and the NHS a great disservice.
In the world of markets and economics, the ‘rational economic
theories’ of Nobel prize winning economists have been humbled by the
events of the past year (3). We can, if we choose, learn some lessons from
this about rationality and empiricism, and recognise its limitations as
well as its usefulness.
2.Greenhalgh T Intuition and evidence—uneasy bedfellows? Br J Gen
Pract 2002 52 395-400
3.Akerlof G, Shiller R. Animal Spirits: How human psychology drives
the economy and why it matters for global capitalism. Princeton University
Press 2009
Competing interests:
None declared
Competing interests:
No competing interests
13 August 2009
John C M Gillies
general practitioner
Selkirk Health Centre, Viewfield Lane, Selkirk TD7 4LJ, UK
Rapid Response:
Intuition and empiricism
Lord Darzi’s observation that questioning and challenge are essential
in any health care system is undeniably true. The argument he quotes that
‘medicine continues to move dramatically from an intuitive level to an
empirical (and eventually precise) one’ demands both questioning and
challenge.
The bold thinking which he rightly says is necessary needs not just
empiricism, but imagination and pragmatism. Empiricism gives us facts. In
the practice of medicine, the facts rarely give a simple way forward, and
making a good clinical decision often demands interpretation based on all
the contingencies of the situation, which include the values of all
concerned , and the resources available to deal with the problem (1).
Precision is welcome but often elusive. Intuition is often needed to make
a decision in the face of uncertainty (2). To suggest that we should be
abandoning intuition as we move an empirical utopia is to do our patients,
the profession and the NHS a great disservice.
In the world of markets and economics, the ‘rational economic
theories’ of Nobel prize winning economists have been humbled by the
events of the past year (3). We can, if we choose, learn some lessons from
this about rationality and empiricism, and recognise its limitations as
well as its usefulness.
John C M Gillies
1.Gillies JCM Getting it right in the consultation: Hippocrates’
problem; Aristotle’s answer. Occasional Paper 86. RCGP Publications 2005
http://www.pubmedcentral.nih.gov/tocrender.fcgi?iid=172824
2.Greenhalgh T Intuition and evidence—uneasy bedfellows? Br J Gen
Pract 2002 52 395-400
3.Akerlof G, Shiller R. Animal Spirits: How human psychology drives
the economy and why it matters for global capitalism. Princeton University
Press 2009
Competing interests:
None declared
Competing interests: No competing interests