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Sutton PA, Hornby ST et al. Bulletin 2015;97: 345–347

The Tooke inquiry into modernising medical careers, made a distinction between the roles of a doctor and other members of the multidisciplinary team. The doctor is the 'handler of (clinical) uncertainty and ambiguity'. In this thought provoking essay, the authors suggest that instinct is an important tool in dealing with uncertainty. Instinct can arise from a desire to cooperate. Cooperation is a component of game theory. Instinct, however, can be distorted by 'confirmation bias' in that there is a tendency to interpret and recall information selectively, ignoring that which does not fit. Other neutralisers of instinct, are the often competing priorities of managing risk and patient expectations, new techniques and materials and legal redress and regulation. Then there is the ever burgeoning evidence-base guidelines and clinical checklists. The authors argue 'it is widely accepted that protocols exist for the guidance of the wise and the blind obedience of idiots'. Clinical gestalt, (gestalt – the 'whole is other than the sum of the parts, often incorrectly translated as 'greater') is a key skill expected of a doctor. It 'entails the active organisation of clinical perceptions into coherent constructs', cogent that these processes may lead to instinct.