Something doesn’t feel right. You can’t put your finger on why, but something about the patient’s status just seems wrong. You look at the monitors and there are no alarms going off, and the patient’s vital signs appear to be normal… but things just don’t feel right. What should you do?

The answer is that there is no one best answer.

When you are able to gather data and analyze your options, you can spend time seeking additional information, running tests, and using tools such as decision aids to help you. Using decision aids and standard protocols for treatment can avoid some of the common biases that plague human decision-making powers, as discussed in Chapter 177. Unless you have time, don’t trust your gut.

However, anesthesiology often operates under time pressure and in situations where complete data are not available. When time is short and you suspect that a problem is developing, trusting your intuition may be the best option.

Intuition is increasingly recognized as an important component of decision making. But what is intuition, exactly? It is the ability to judge a situation on the basis of information that is activated in memory but not consciously retrieved. People making decisions often recognize patterns of information without consciously naming those patterns.

There is little or no information on intuition in the anesthesia peer-reviewed literature. However, since the 1990s, researchers have looked at its role in a number of other areas including firefighting, industrial and chemical processing plants, corporate and business planning, nursing units, and pilot and military situations (the nursing and military studies are perhaps the most relevant to anesthesia care). Gary Klein is one author in the field of recognition primed, or “naturalistic,” decision making who has published a number of interesting recent studies. He estimates that as many as 95% of decisions in naval aviation (specifically those of the antiaircraft warfare operators in the AEGIS Cruiser) involve recognition of a specific situation, not a choice between alternative actions. He has also studied the phenomenon of neonatal intensive care nurses “sensing” when a baby’s health was deteriorating before any tests or monitors picked up on the problems. Klein was actually able to determine what cues the nurses were subconsciously
picking up on in making their “intuitive” diagnoses. Also, although the exact mechanisms underlying intuitive judgments are still under discussion, it has been established that study subjects can make intuitive judgments about linking coherent or disqualifying incoherent data triads in as little time as a few seconds.