We often use our intuition or gut feeling, which is also referred to as “gestalt,” to make snap clinical decisions. How good is our gestalt and can years of experience really make our gestalt even better? Gao et al (10.1542/peds.2020-041582) evaluated clinical intuition in an interesting study being early released this month in our journal.
The authors analyzed data from a prospective cohort study of children 3 months to 18 years of age. In this study, clinicians examined 634 children who had a lower respiratory infection and received a chest radiograph (CXR). These clinicians were then asked to predict using their gestalt, the probability that the patient would develop severe complications of community acquired pneumonia (CAP) (e.g., respiratory failure, empyema, lung abscess, sepsis, and other severe complications). The clinicians did a great job with their predictions when they had a very low or very high suspicion for a complication, but they did not fare well when their predicted risk was in a low-intermediate category, which is where most children with CAP tend to be.
Do we give up on the use of using our gestalt at least when it comes to predicting severity of pneumonia? Not quite yet, according to a terrific commentary (10.1542/peds.2020-048637) by infectious disease experts Drs. Yasaman Fatemi and Louis Bell from Children’s Hospital of Philadelphia. The authors of the commentary provide an analysis not only of the findings in this study but of gestalt thinking compared to a slower and more analytic approach to thinking. Both types of thinking have their strengths and limitations as pointed out in this commentary. Drs. Fatemi and Bell caution us not to rely on gestalt alone but rather enhance our gestalt thinking with some good old evidence-based decision tools. Link to both the study and commentary, and you’ll find you’ve made an excellent decision!
