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Comment by rsync | Hacker News Reader

Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic.

Also of tremendous import is "gut feeling" which is called out specifically in the article:

"Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why."

The disorganized, indescribable, cumulative knowledge of a human practitioner who has seen thousands of cases is so valuable that it should be given very particular nomenclature and afforded tremendous esteem - even more so than the physicians with their decades of schooling.

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I don't deny that Taleb brings some great insights, but specifically to the phenomenon you describe, a more relevant book could be Kahneman "Thinking, fast and slow".

The "gut feeling" is framed as the result of expertise + many hours of practice with short feedback loops. Intuition is very valuable and esteemed, much like a chess Grandmaster can say "Mat in 4" just by glance at a game, where you would need many hours of thinking to arrive to, at best, a similar conclusion.

Thinking slow is where we start when we learn a skill (from learning to count when we are toddler, to learning to code, play piano or chess, or practice medecine). It is a conscious, slow, energy-hungry process that leave us tired. After many hours of practice, and, importantly, short feedback loops to feed our internal pattern-matching algorithm, we start to "Think fast".

Thinking fast is quick, easy, not easily described by words as a lot of it happens below consciousness. It is very efficient but also error-prone, as it is based on heuristics. A lot of cognitive bias come from it.

> The disorganized, indescribable, cumulative knowledge of a human practitioner who has seen thousands of cases is so valuable that it should be given very particular nomenclature and afforded tremendous esteem

“Clinician gestalt.” Non-inferior to almost every clinical decision rule we’ve tested, or otherwise incorporated therein (eg, Wells’ “most likely diagnosis” criterion).

I work with a lot of physician colleagues (as well as veterinarians) and one of the things I wish we could capture was what words someone uses to trigger those gut feelings. The way a patient describes their pain, how we try to wrap our language around complex disease concepts...

If you are focusing on words, you are missing the big picture. 'Guts feelings' are what you get when your brain process a butt load of informations in a fuzzy way. This includes subtle smells, colors, moves, timing, shapes, sounds, chain of events and how they interact with each others.

Words can be a tiny part of it, but usually gut feelings are about all those things you can't process as easily with rational thinking and so rely on a different, less precise and more general, method of analyzing. This does not play well with language, which is very accurate and precise, very intellectual.

It's why we can easily walk, but have a hard time describing how we walk.

A commenter on HN talked about the book "The inner game of tennis" not so long ago. I highly recommend it to get a gentle introduction to this part of us. Especially on this site, where a lot of us are geeks who are more used to leverage their rational thinking than their feelings.

Last year, many commenters talked about meditation. While I do recommend the practice, starting from the sport point of view is way easier to swallow and make a better starting point for people with strong affinity with precision and step by step logic.

The gut feelings a health care professional gets will vary based on the language the patient uses.

The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".

Your example perhaps doesn’t lend itself to a discussion of “gut feelings”, since it describes different symptoms quite specifically. In the absence of other information, the first sounds like a heart attack, the second, heart-burn (acid reflux).

Gut feeling relies on more abstract concepts, particularly in the context of pediatrics where a child may be unable to verbalise their symptoms.

I agree the specific example is somewhat explicit, but the point being made is valid. Whether it's a subtle choice of words, lack of eye contact, or constant fidgeting. They can all have some additional meaning (or none!).

One example that I've heard is common is about reading body language that might indicate discomfort in talking about a subject, which might suggest under/mis-reporting of an issue.

> The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".

Those are quite direct description of symptoms.

The gut feelings a doctor has will be affected by words used by the patient or their relatives.

It is interesting to talk with a family member who is a physician mainly for male veterans of the armed forces. He's got roughly the same training as someone who would treat families, but because he's worked with this older/sicker/male/poorer population with particular shared experiences, he's really developed an ear for what these guys are saying and not saying. It's a whole set of para-medical skills that do not transfer to children, women, guys who come from a very different demographic or cultural profile.

So I sort of agree that gut feeling varies based on the language a patient will use, but knowing your patient population well can help you tune in beyond the words.

I chose words for two reasons:

- First, they're super-hard to capture. "What did a patient say to me?" doesn't end up on medical record systems.

- Second, that's what they often describe to me. That the patient was describing something, and they weren't sure why, but it made them worried.

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