This question was originally posted on Quora.com and was answered by Michael Keyes, M.D. Psychiatry, Tulane University School of Medicine (1970) There was a study done on this question in which patients with incomplete or ambiguous signs and symptoms were presented to a group of residents, attendings and professors, the latter who were considered at the top of the profession. The study was initially supposed to determine what processes each of the classes of physicians (students, experts and masters of medicine) used: rules vs. experiential methods of decision making. These physicians were specialists in different branches of medicine so the researchers were also looking for bias in their decisions. They found a) all of the physicians initial diagnoses were more or less related to their field of study, b) the younger doctors used rule based decision methods (looking at the information and fitting it to known parameters) c) the older physicians used their experience to come to a conclusion which was often better than the residents and d) that the master level physicians, while still having a mild tendency towards their specialty, were able to have a broader differential diagnosis list that usually included the diagnosis that best fit the example given. Another finding showed that the master level doctors initially used an experiential heuristic, but upon realizing that the answer was not so clear cut, used a rule base method afterwards but were much more accurate with it due to their experience and mastery of the subject. Other studies show that experts who “follow their gut” are usually right more often than the rules based experts. The master level physicians go a level above that. I think that every doctor has had this experience sometime in their career, especially as a student or resident. I remember seeing a very distinguished liver specialist examining a mystery (to the other doctors) patient for only a few minutes and coming up with what ended up being the correct (and rare) diagnosis. These are talented and hard working physicians who have mastered medicine, a rarity in any domain. Their brains are different, they are more talented and they have a different relationship with medical knowledge. Many are intellectually creative and they all are easy to spot in a group of doctors. Source
