Clinical intuition: how paramedics make decisions, is experience always best? A case presentation

When presented with a patient with an undiagnosed neurological condition, how do you decide how to proceed? In the challenging out-of-hospital environment intuition or experience may be your main resource, but could also be a hindrance. It is difficult to define intuition, but it is often seen as incorporating rapid perception to make decisions, and not being aware of the processes involved (Gobet and Chassy, 2008). With paramedics being required to make more and more decisions as part of their practice, including discharging at scene, treat and refer systems and ultimately not transferring all patients to the ED, it is vital to understand the decision-making processes undertaken. By thoroughly understanding the processes that paramedics undertake, education can be targeted to incorporate these. Training practitioners to actively avoid the pitfalls of these techniques should help to reduce the likelihood of error in the future.

Firstly, it is important to consider why particular decisions are made, whether diagnoses are correct and what assumptions are made about the patient. It is pertinent to reflect on whether there were any errors and the reasons for them, in order to guide future practice.