“What do you mean, we use intuition?” The productive silence of diagnostic intuition: Examining the impact of the "absent present" in healthcare

This paper explores the theoretical development of the "absent present," as conceptualized by Michel Callon and John Law, within the context of healthcare practice and explicit attention for the agency of the non-material, specifically words, or the active silencing thereof. Based on fieldwork in international hospitals (2020-2024), I argue that healthcare professionals often downplay the significance of their diagnostic intuition in public discourse, driven by a desire to conform to narratives of evidence-based and rational practice. This tendency not only marginalizes a vital aspect of effective caregiving but also heightens the risk of healthcare being increasingly replaced by technology. In addition to employing Gofmans' frontstage/backstage analogy, this article integrates two theoretical perspectives: Jeannette Pols' concept of 'radical relationality' in healthcare, which emphasizes that all care is relational and context-dependent-shaped by people, technology, and language-and Michel Anteby's insights into active silencing, which demonstrate that the deliberate omission of certain words or topics can serve as a productive relational practice. Building on Pols' argument that framing experiences narratively influences conceptions of effective care, I extend the discussion to show that the omission of words and concepts-whether through silence or exclusion-also constitutes a form of relational practice. My analysis reveals that the words nurses choose to publicly describe their work, as well as the silences they maintain about specific topics, can inadvertently produce unintended and potentially problematic outcomes. Ultimately, the paper critically examines how public silencing of crucial aspects of healthcare professionals' work can undermine the quality and effectiveness of healthcare delivery, and how recognizing the productive role of both visible and invisible aspects of relationality can offer deeper insights into the integration of human expertise and technology in healthcare.