title: Making sense of things.
abstract: Practice is fundamentally built on a sense for what is the case. Ideally, there is a scientific or at least rational overlay. But practice is inescapably grounded in flash judgments made by professionals trained to do so. There is virtually no scientific literature about this most basic type of clinical knowledge. Sensing is instantaneous, uncensored, never in doubt, meaningful, and emotion-laden. It grasps relationships as a whole pattern, with no moving parts. When it is put into words or when justifications are offered, these are add-ons that are not part of the original sensing. The way we navigate in the world is often a sandwich of sensing, then thinking, then sensing. We can even "know" in both ways at the same time, but the result is not always harmonious. For example, rational activity is impaired by distraction, but sensing is not and there are gaps between what we sense and what we report about what we sense. In general humans are spontaneously non-objective; over-diagnose the likelihood of complex conditions; misremember things in the past in self-serving ways; express too much confidence in what we think we know; make too optimistic estimates for project completion; and ignore baseline information when given even faulty bits of partial evidence. Professional judgment is often inaccurate, compared with objective alternatives, but professionals seem to prefer it that way.
authors.forename: David W
authors.initials: DW
authors.lastname: Chambers
mesh_terms: D003815:Dentists / Q000523:psychology*; D006801:Humans; D019545:Intuition; D008606:Mental Processes