How to use intuition when making hard medical decisions
“Oh it's very simple. My secret had been I know what to ignore.” - Francis Crick, on what it takes to win the Nobel Prize.
"In the end, the hard decisions inescapably involve imponderables of intuition, prudence, and judgment.” - John F. Kennedy
Important decisions require intuition. As with all tools this comes with potential for massive value, but also with the risk of errors. In this post I'll detail how to consider your own intuition when you’re engaged with the healthcare system.
Why it matters
How might we think about the role of intuition when it comes to making hard medical decisions - especially if we have little/no experience in this area?
First, it’s critical to understand that the risks of mis-applying our intuitions to a situation of this magnitude can be immense. Medical decisions should be thought of as one-way doors. No matter how seemingly inconsequential the decision, the potential for unexpected issues is always present.
So how do we involve ourselves effectively in medical decisions if we are not doctors, or even medically literate? First, understand that not being a doctor does not disqualify our intuition! The key is to ask the right sets of questions, reducing the problem to one we are capable of reasoning about. We must know what to ignore, to distill the essence of the problem.
The good news is that most of the time these decisions are not fundamentally hard. The trick is to cut through (and not be intimidated by!) the medical jargon.
Here’s how to do this:
1. Understand the situation and the problem to solve
Unless it’s an elective surgery or similar, it’s often true that you’ll be given this by the doctor. You’ll also likely be given a set of options. While these may not be fully exhaustive (which is the topic of another post) this should serve as a starting point for present purposes.
2. Define what a good outcome looks like
This is something you must own. If this is an elective surgery, define the outcome you are looking for. This includes fully understanding the risks/benefits. What are the downsides if this treatment doesn’t go well?
Define your values. Ask, what if this doesn’t go as expected? Would I regret the decision/treatment I went through? Why?
Decide
I like to think about hard medical decisions as a multi-gated system.
Rigorously analyze a situation, including outputting a logical decision.
Gut-check by asking: how does this *feel*? If it feels good, aligning with intuition then you're in good shape. In my experience it’s often the case that something won’t feel right because some critical piece of information is missing. This is an opportunity to poke holes in your analysis. And this is where the intuition comes in. Sometimes our gut indeed is smarter than our cortex!
If for some reason the decision doesn’t feel good, you should go back and try to understand why.
Run it through the system again and see if that fixed it.
Very often it's the case that the rational decision doesn't jive with intuition - at least on the first try. This is a good thing! The reason is that we have an opportunity to dig into the nature of this gap. Sit with it, write about it, talk about it - whatever works for you. The key is to understand the problem at a deeper level. Ask: why don’t my brain and my gut align?
Did the analysis miss something important?
Would a negative outcome to the decision lead to regret? Did I mis-calibrate my risk tolerance?Are the costs too high for some reason?
Is the doctor optimizing for something that you don't care about (e.g., in an extreme case proposing painful/costly/high effort procedures that only marginally improve a prognosis?).
This is a good method to refine the decision and get to a place that makes both rational sense, and that you'll feel good about.