Posted by katekite on June 15, 2002, at 19:24:08
In reply to Re: intuition--the sixth sense » IsoM, posted by beardedlady on June 15, 2002, at 14:46:42
There's intuition, that sixth sense that we can't stop ourselves from using. Some study showed most job interviews were basically over by one minute: the first impression was so much more important than resume etc (at least for the job in this particular study), and I would guess this could be called an 'intuitive' assessment of the person.
Then there's intuition based medicine. Intuition based medicine is prescribing based on seeing a patient and getting an intuitive sense of what their problem is and comparing that person to people seen before and what medications worked for them. Some patients like this approach as it seems more like magic and they don't have to worry about their choices.
The alternative to intuition based medicine is Evidence Based Medicine (EBM). Evidence based medicine is using statistics of clinical studies, and the input and wishes of the patient in combination and treating each case on an individual basis. For example a standardized interview or questionaire like the mmpi to establish a single diagnosis of major depression, then follow any popular algorithm for treatment. If the algorithm suggests using an ssri first, then the proper EBM thing to do is not choose for the patient but allow the patient to choose among them by outlining their likely effects (prozac seems to increase energy more than paxil but paxil may be better for sleep, celexa is said to have fewer sexual side effects, etc, which would you like?).
In psychiatric medicine the input of the patient can sometimes be hard to get -- some people may be too depressed or too freaked out to be able to think clearly about their medication choice or even about their answers to questions. This means psychiatric medicine is more prone to use of intuition.
To me it seems that the specialists who use intuition based medicine the most, independent of client wishes for it, are psychiatrists: it may be from repeated experience of patients like I mention above or it may be lack of clinical studies and the plethora of drugs available.
Most docs probably use a combination although more and more they may try for a purely evidence based approach. Then again if there aren't a lot of studies, if a medication is new, then it is all based on intuition as there is no alternative. The older docs get, the harder it is not to be biased by individual experience (if randomly every patient you try serzone with stays depressed, you'd have trouble using it routinely).
So asking someone if they use intuition is a hard question. It might be easier to ask if they are a hard core EBM person or a combo person or tend to go with their impression and experience.
Kate
poster:katekite
thread:5602
URL: http://www.dr-bob.org/babble/admin/20020510/msgs/5643.html