Sunday, October 01, 2006

The role of intuition vs. the role of knowledge

A topic that I have been hoping to address is the role of intuition vs. the role of knowledge. Does intuition have any place at all in caring for patients? Is intuition even a form of knowledge? Or is the claim for a role for intuition just a not so subtle effort to deflect attention from lack of knowledge.

I was reminded of these question when reading an entry from a midwifery blog on the issue of postpartum hemorrhage. Navelgazing Midwife speculates that an injury she sustained while setting up for a birth was a sign that the patient was going to experience a life threatening hemorrhage. I suspect that this had little, if anything to do with the midwife's premonition of potential disaster. She actually was in possession of knowledge that this patient was in danger of life threatening hemorrhage. It had happened before.

I wholeheartedly agree with Navelgazing Midwife's decision to transfer the patient to the hospital. In my judgment, it was inappropriate to consider a homebirth in the first place since a previous postpartum hemorrhage increases the risk of a subsequent postpartum hemorrhage by almost 300%. I especially agree with Navelgazing Midwife's assessment that her decision to transfer the patient almost certainly saved the patient's life. The comment criticizing her for sharing this information with the patient was worse than inane, it was dangerous. The patient has a life threatening predisposition to postpartum hemorrhage. This is something that the patient MUST be told in order for her to make informed decisions about her future care. Depending on the circumstances of the hemorrhages, the patient may need further evaluation to be sure that she doesn't have a coagulation disorder that could impact any future injuries or medical procedures.

A very important question remains, though. Why look for guidance in intuition when only knowledge can provide the answer?


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