Klinische Intuition - Möge die Macht mit dir sein...

"Use the force, Luke. Let go!" He turned off his targeting computer—certain folly! But the torpedoes went down the ventilation shaft and Death Star, the most advanced weapon ever to threaten the universe, exploded. The whole cinema jumped and whooped as one. My brother shouted, "Even better than Smokey and the Bandit." We spent the next few years imaging we were duffle coated Jedi knights, following the code and saving the universe, tapping into the timeless and invisible power of "the force." Light-sabre sticks spluttered and buzzed as we mimicked the noises and the voices of Stars Wars. I not sure whether I still believe in the force, but I do believe in something even more unlikely: clinical intuition.
It is hard to explain the ancient power of clinical intuition to the young "padawan" of the i-generation, whose only faith is the binary code of the microchip. But a few of us still believe. You can spot them: in general practice their garb is brown corduroys or tweed skirts and jackets with leather patches. In the hospital their trousers are too short and they wear the same shirt every day, but it is their footwear—comfortable brown Clark's shoes—that marks them apart. Understated and seemingly invisible, they quietly get on with clinical commitment in all the unfashionable corners of the NHS. Their colleagues, especially the young ones, shackled by evidence based medicine, smirk at their mumbled ancient incantations, such as, "That just doesn't fit with the story," and, "There's something else going on."
But over many thousands of clinical contacts some vividly stand out where clinical intuition saved the day and saved lives. Intuition is hard to put into words but is a sense that something somehow is just "not right." It is a change in the smooth and regular wave forms that radiate from patients—perhaps a change in the tone, pitch, or pace of their voice or a change in posture. But really intuition is just a feeling, a disturbance in the clinical force. These odd experiences are shared by many of us but are spoken of only in hushed and embarrassed voices, for fear of being overheard.
Clinical intuition is stronger in some people but is present in all of us. It is just a question of tuning in, letting go, and trusting. But this is medical heresy in these days of the randomised controlled trial and systematic review, in this evil empire of technological medicine. However, I will try to instruct students in the old ways for as long as I can, before the Empire's stormtroopers close in and I face banishment to the far-off and desolate planet of Protocol.

Des Spence, general practitioner, Glasgow
destwo@yahoo.co.uk
BMJ 2007;335:1158 (1 December), doi:10.1136/bmj.39412.648576.94