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21.04.2022 | Scientific Contribution

The medical gap: intuition in medicine

verfasst von: Itai Adler

Erschienen in: Medicine, Health Care and Philosophy

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Abstract

Intuition is frequently used in medicine. Along with the use of existing medical rules, there is a separate channel that physicians rely on when making decisions: their intuition. To cope with the epistemic problem of using intuition, I use some clues from Wittgenstein's philosophy to illuminate the decision-making process in medicine. First, I point to a connection between intuition as functioning in medicine and Wittgenstein's notions of "seeing as" or noticing "aspects". Secondly, I use Wittgenstein notion of empirical regularities hardened into rules to suggest that there are two stages that should be addressed in the analysis of medical practice: the first concerns the accumulation of cases and the second pertains to the setting a rule based on these cases. I argue further that the medical context is exceptional in that the two stages are intertwined and, and explain the consequences of this fact for the physician's work. Finally, inspired by Wittgenstein's rule-following conundrum, I argue that medicine is particularly prone to difficulties in applying a general rule to a specific case represented by an individual patient. Recourse to intuition is reflects the physicians' efforts to bridge this gap.
Fußnoten
1
The discussion that follows can be considered part of the debate regarding rules and their applicability to individuals, a topic that has been considered since Aristotle, through Kant, and all the way to Wittgenstein. Hence, it encompasses too wide a scope to be exhaustively treated in this description. We will however address the relevance of this issue to medical practice later.
 
2
See, for example, (Cowen and Kattan 2009, 638–640; Jameson et al. 2018, 14–16). Feinstein (1967, 26) criticized the use of intuition in medicne, and instead suggested the "clinical judgment". See (Feinstein 1967).
 
4
There are two common perceptions about intuition in the philosophic discourse, but they imply metaphysical assumptions which are less compatible with the Wittgensteinian approach which I want to develop here:
1.
Intuition as a belief or an underlying reason for a particular belief intuition is a belief or attitude ((Lewis 1983) x), or the cause of a belief (Williamson 2007, 257–270). The two types of phenomena, belief and intuition, are similar in that they both lack a rational justification and yet constitute a significant source of authority. Furthermore, there appears to be a connection between the two phenomena, given that someone who has a particular intuition usually—albeit not always—believes in it.
 
2.
Intuition as a Sui Generis phenomenon According to this approach, intuition is a unique type of perception with a unique epistemic status; in other words, in a unique way, intuition leads to a true claim (Bealer 1998, 207; Bengson 2015, 707–760; Chudnoff 2014, 625–654; Koksvik 2011, 257–262). The advantage of this approach is that it restores the original meaning of the word intuition. It implies a substantial degree of passivity on the part of the subject, suggesting that the observer is obligated to accept the intuitive claim. The disadvantage of this approach is that it necessitates the creation of a new mental state.
 
 
5
Glock explantion of "seeing as" according to Wittgenstein is similar to Bengson (2015) account about intuition.
 
6
As doctors like to say "there is always a DD (= differential diagnosis)", which in this context means other medical options.
 
7
We may wonder whether the disease might have changed over the years, that is, whether Dr. Parkinson’s six patients had Parkinson’s disease as it is defined today.
 
8
For example, in some European countries, appendicitis is treated with a course of antibiotics, whereas in the US, surgery is the accepted treatment. The same is true of medications, Metamizole (or dipyrone) is banned in the US, but is sold over the counter in Israel.
 
9
I later consider a one-person experiment, in which the physician does not know which treatment is being administered, as the patient is randomly assigned one treatment and then another.
 
10
As suggested by Montgomery: “Medicine, if it is a science, is that oxymoron, a science of individuals, which Aristotle in the Metaphysics declared was an impossibility” (Montgomery 2006, 32).
 
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Metadaten
Titel
The medical gap: intuition in medicine
verfasst von
Itai Adler
Publikationsdatum
21.04.2022
Verlag
Springer Netherlands
Erschienen in
Medicine, Health Care and Philosophy
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-022-10081-4