Author: Gerd Gigerenzer
‘Can following your gut feelings lead to some of the best decisions?’ ‘Can we trust our guts?’ These are the intriguing, even if superficially naïve, questions posed in this book. The author defines a gut feeling as ‘a judgment that appears quickly in unconscious; whose underlying reasons we are not fully aware of, and is strong enough to act upon’ (page 16). He says these intuitions are evolved rules of thumb which reside in the mind’s ‘adaptive toolbox‘ (page 19) and they are as valuable as other evolved capacities such as language, recognition memory, imitation and emotions (page 58). Intuitive decision-making relies on gut feelings or hunches which are subconscious. Unlike ‘rational’ (conscious) decision-making, the subconscious has a much larger capacity; the book therefore argues that in many situations, intuitive decisions generate better judgments.
The author, a psychologist at the Max Planck Institute for Human Development, illustrates the value of gut feelings in a variety of settings. He shows how they contribute to expert performance, describing how experts seem to intuitively generate the best options first (page 33). He demonstrates that ‘…the gut reaction was, on average, better than the action taken after reflection’ (page 34), and ‘taking time and analyzing did not generate better choices’. He shows that intuitive decision-making equally applies to mundane situations, and in some cases the ‘collective wisdom based on individual ignorance can even outperform experts’ (page 133).
Gut feelings rely on heuristics or shortcuts. The most important shortcut according to the book is the recognition heuristic and its variants such as ‘take-the-best’ and ‘one-reason’ decision-making. The book cites several studies which show the validity of this heuristic ‘in a broad range of real-world situations’ (page 150). He discusses the ‘less-is-more effect’ and the situations where access to restricted information leads to better judgments (pages 37-38).
There are many criticisms of intuitive decision-making and the author addresses some of these. He refers specifically to the well-known Linda problem, popularised by Daniel Khaneman and Amos Tversky. This problem lists some features of a woman and asks people to make a judgment on what type of person she is. Most people make the wrong assumptions by relying on the framing heuristic. The author however argued that the Linda problem is wrongly framed and does not take into account real life situations. He cites studies which have deconstructed the problem and which show that ‘…often what looks like a reasoning error from a purely logical perspective turns out to be a highly intelligent social judgement on the real world’ (page 103). He said that the framing heuristic ‘can communicate information that is overlooked by mere logic’ (page 99).
The author addresses decision-making in healthcare and he draws attention to the difficulty doctors have understanding complex decision aids (page 168). He compares intuitive and rational (protocol-driven) decision-making; he describes an illustrative coronary care study which shows that a one-reason, fast and frugal, intuitive decision-making tree performs better than other decision systems. Based on this and other studies, the book recommends training medical students to apply intuitive decision-making ‘in a disciplined and informed way’ (page 169). He argues that ‘truly efficient health care requires mastering the art of focusing on what’s important and ignoring the rest’ (page 178). His take home message is ‘…trust your intuition when thinking about things that are difficult to predict and when there is little information’ (page 251).
The book gives a good account of intuitive judgments and complements book other publications such as the self-explanatory The Power of Intuition by Gary Klein. The author has personal research involvement in the field of heuristics and has written extensively on the subject. The book makes a case for the value of intuitive judgments in real-life situations, and explains when these judgments are reliable. His writing is clear and to the point.
I was particularly interested in his healthcare-related examples which are spread throughout the book; this is pertinent to doctors who make quick and critical judgments often with limited information and within restricted time-frames. The concept of the ‘less-is-more’ effect may be controversial and require ‘suspending disbelief’; the author however argued it rather convincingly and specific when less knowledge aids decision making.
There are several graphs and charts which did not make the topic any clearer for me but I appreciate that some people will find these useful. I also did not think the discussion on ‘social instincts’ fitted in with the overall theme of the book and I got the ‘gut instinct’ it was tagged, but it was nevertheless interesting.
The book addresses a topic relevant to healthcare and does so with excellent illustrative examples. The lessons in the book are pertinent to all doctors and I recommend it.