Trust your gut instincts … or not! - Literature Review - Column

Physician Executive, Nov-Dec, 2003 by Phillip M. Kibort

IN THIS ARTICLE ...

Discover two opposing views of whether smart business exceutives should trust their intuitions or ignore their gut feelings.

Many of my clinical colleagues in medicine believe that since I went into management I've gone to the "dark side." In fact, I found that both fields can learn a tremendous amount from each other.

The recent phenomena in business of learning and focusing on systems thinking, complex science or chaos theory are all familiar concepts within medicine. Not surprisingly, the business world has been able to adapt some of the thinking from the field of science and biology to management practice.

At the same time there is much that physicians can learn from management theory and practice. Many concepts can be applied to how we interact with our patients, the populations we care for and, of course, how to operate the business of medicine.

No matter what level you're working at--as a solo practitioner or as the CEO of a integrated health system with thousands of employees and hundreds of stakeholders--the business side of your life takes specialized knowledge and understanding.

One concept that plays a major role in both disciplines is intuition.

The role of intuition

Most of us think we know what intuition is. At the same time, it's still not perfectly understood if we are born with it or learn it. People generally agree that intuition refers to the brain's process of interpreting and reaching conclusions about phenomena without resorting to conscious thought.

In 1977, the Boston Consulting Groups wrote "intuition is the subconscious integration of all experiences, conditioning, and knowledge of a lifetime including the cultural and emotional biases of that lifetime."

The debate currently raging in the business sector (and, you could argue, in the clinical world) is whether you should trust your intuition in making decisions or ignore it because of its lack of critical analysis.

The debate can best be studied through two recent authors taking opposing views about it. Gary Klein, in his recent book, Why Developing Your Gut Instincts Will Make You Better at What You Do (1), and Eric Bonabeau in his recent article, "Don't Trust Your Gut." (2)

Klein takes the view that intuition is extremely important and essential in decision making. He uses multiple examples of firefighters, intensive care nurses, marines and leaders who use their intuition to come to decisions in a rapid rammer because of their intuition skills.

We've all had "gut feelings" when faced with making choices at work. For example, you may have evaluated a job candidate when your gut told you "something" seemed wrong. Because there is no way to quantify, these hunches you dismissed them as untrustworthy, only to discover later that your intuition was right all along.

Klein demystifies the role intuition plays in the workplace and gives us permission to trust our instincts. He shows that intuition, far from being an innate "sixth sense," is an essential and learnable skill that anyone can use to improve job performance.

Klein concludes that 90 percent of all critical decisions are based on intuition. We use it all the time. It's a subconscious process that infiltrates just about every aspect of our work lives. It is as important a tool in making a decision as interpreting numbers or analyzing data.

Intuition and experience

Though it's difficult to explain where it comes from, it's based on our ability to recognize patterns and interpret cues. In addition, according to Klein, intuition can develop as we gain experience in our fields.

Klein makes a particular case for the widespread use of intuition in nursing and other clinical work. He relays how experienced neonatal intensive care nurses are able to observe and see patterns in preemies regarding their health status well before inexperienced nurses who depend on data.

When Klein studied firefighters, he noted that they don't make conscious decisions as they approach a major fire. On the contrary, the firefighters felt that they were "just acting." They did not make systematic comparisons of decisions, but acted on their intuition. The firefighters don't sit and analyze different scenarios and weigh the pros and cons. Rather, they see patterns and make decisions based on their experience.

The fact that firefighters under pressure act on intuition shouldn't surprise us. Most people would never get through the day if they had to analyze every decision before they made it, and certainly not within a highly stressful and fast-moving environment like firefighting--or caring for patients.

Intuition is an essential, powerful and practical tool. Flawed though it is sometimes, we could not survive, much less excel, without it.

Klein also discovered that the more experience people have in any particular field, the more they rely on intuition, because intuition is a natural and direct outgrowth of experience. He defines intuition as "the way we translate our experience into action." In other words, our experience lets us recognize what is going on and make decisions.