John Goldie is a retired GP and Medical Educator
What do we mean when we call someone ‘a clever doctor’? Is it their diagnostic flair, their encyclopaedic memory, or something subtler — like knowing when to pause, listen, and say less?
Intelligence is a human trait that varies across the population and is often measured using psychometric tests, most famously the IQ test. Originally developed in the early 1900s to identify children needing extra support in school,1 IQ tests now assess reasoning, memory, language comprehension, and problem-solving. Your score reflects how you compare to others your age.2
On average, males and females score similarly, though they may differ in task performance: males often excel in visual-spatial tasks, while females tend to outperform in verbal fluency and processing speed. Differences in IQ scores between racial groups have been observed, but scientists agree these reflect environmental, social, and cultural factors — not genetics.3 Most people’s IQ scores remain stable throughout life, though adolescence can bring volatility. Staying mentally active helps preserve thinking skills but rarely shifts IQ itself. A higher IQ may buffer age-related cognitive decline.4
“Experts often define intelligence as problem-solving, learning, and reasoning.”
During the 20th century, average IQ scores rose across generations — a trend known as the ‘Flynn effect’, attributed to improved nutrition, education, and reduced exposure to toxins.5 More recently, this rise has plateaued or reversed in some developed countries, possibly due to shifts in education, youth culture, or test design.6
Yet IQ, for all its statistical elegance, captures only a sliver of what it means to be intelligent — especially in the messy, relational world of medicine. While higher scores correlate with academic and professional success,3 IQ tests can conflate test performance with true human potential. They’ve been misused historically in eugenics and immigration policy.7 Genetics play a role, but only about 20% of the genetic influence on intelligence has been identified.8 Environmental factors — and their interplay with genes — remain crucial.
Experts often define intelligence as problem-solving, learning, and reasoning.9 But this view is narrow. IQ tests miss vital dimensions like creativity, emotional intelligence, and social skill.7 Broader models include emotional (EQ), social (SQ), and adversity (AQ) intelligence.10 Gardner’s theory of multiple intelligences expands the landscape further: linguistic, logical-mathematical, spatial, bodily-kinaesthetic, musical, interpersonal, intrapersonal, naturalistic, and existential.11
So, what do we mean when we call someone ‘intelligent’? In medicine, we often think of diagnostic acumen, guideline recall, or the knack for spotting subtle signs. But intelligence is never just cognitive. It is also relational, cultural, and increasingly technological.
“Our daily work is saturated with prediction: anticipating the course of an illness, the impact of a social stressor, or how a patient might respond to a treatment plan.”
Neuroscientists have further mapped the brain and point to specific regions — such as area PF in the left inferior parietal cortex — as markers of technical reasoning.12 Philosophers remind us that cognition may extend beyond neurons, into networks and systems.13 Computer scientists like Blaise Agüera y Arcas argue that prediction — the ability to anticipate what comes next — is the essence of intelligence, whether in humans or machines.14
This matters for general practice. Our daily work is saturated with prediction: anticipating the course of an illness, the impact of a social stressor, or how a patient might respond to a treatment plan. Yet intelligence in practice is not only about prediction. It is also about socialisation — learning the hidden curriculum of medicine, absorbing the tacit norms that shape what counts as ‘good judgment’.15
Artificial intelligence (AI) complicates this picture. Language models predict the next word; clinicians anticipate the next turn in a patient’s story — a task that demands not just data, but empathy, context, and moral imagination. AI can generate plausible advice, sometimes appearing morally superior through stylistic polish.16 But its ‘intelligence’ is socially mediated: it depends on how we interpret and trust its outputs. In this sense, AI is not just a technical tool but a participant in our social world.
Social intelligence, then, becomes indispensable. In medicine, it means reading the room, understanding the patient’s context, and navigating professional identity. Sociological studies show that what counts as ‘intelligent’ behaviour is often tacitly defined by peer expectations and cultural scripts.3,10,16-18 Intelligence is not only an individual property but a socially mediated one.
“If prediction is the heartbeat of intelligence, then perhaps the soul of medicine lies in how we listen, not just to data, but to each other.”
Philosophical work on distributed cognition pushes this further, suggesting that intelligence may emerge from networks of interaction — biological, technological, and social. Espionage and geopolitics offer striking parallels: intelligence in these domains is less about raw cognitive ability than about strategic coordination, deception, and relational skill under uncertainty.18,19
Perhaps the lesson is that intelligence is always plural. It is embodied in brains, manifested in machines, and embedded in relationships. For general practice, this means recognising that our professional intelligence is not just about knowledge but about how we relate — to patients, colleagues, and increasingly, to technologies that challenge our boundaries.
If prediction is the heartbeat of intelligence, then perhaps the soul of medicine lies in how we listen, not just to data, but to each other.
References
1. Binet A, Simon TH. The Development of Intelligence in Children. Baltimore: Williams & Wilkins; 1916.
2. Wechsler D. The Measurement of Adult Intelligence. Baltimore: Williams & Wilkins; 1939.
3. Neisser U, Boodoo G, Bouchard TJ Jr, et al. Intelligence: knowns and unknowns. Am Psychol, 1996; 51(2): 77–101. DOI: 10.1037//0003-066X.51.2.77
4. Deary IJ, Corley J, Gow AJ, et al. Age-associated cognitive decline. Br Med Bull, 2009; 20(6): 682–8. DOI: 10.1093/bmb/ldp033
5. Flynn JR. Massive IQ gains in 14 nations: what IQ tests really measure. Psychol Bull, 1987; 101(2): 171–191.
6. Bratsberg B, Rogeberg O. Flynn effect and its reversal are both environmentally caused. PNAS, 2018; 115(26): 6674–6678.
7. Gould SJ. The Mismeasure of Man. New York: W.W. Norton; 1996.
8. Plomin R, von Stumm S. The new genetics of intelligence. Nat Rev Genet, 2018; 19(3): 148–159. DOI: 10.1038/nrg.2017.104
9. Snyderman M, Rothman S. The IQ controversy, the media and public policy. Piscataway: Transaction Books; 1988.
10. Sternberg RJ. Successful Intelligence. New York: Plume; 1997.
11. Gardner H. Frames of Mind: The Theory of Multiple Intelligences. New York: Basic Books; 1983.
12. Chis-Ciure, R, Levin, M. Cognition all the way down 2.0: neuroscience beyond neurons in the diverse intelligence era. Synthese, 2025; 206(257).
13. Federico G, Ilardi CR, Marangolo P, et al. Left area PF as a neural marker of technical reasoning. Brain Struct Funct, 2025; 230(9):173. DOI: 10.1007/s00429-025-03043-y
14. Agüera y Arcas B. What Is Intelligence? Cambridge (MA): MIT Press; 2025.
15. Goleman D. Social Intelligence: The New Science of Human Relationships. New York: Bantam; 2006.
16. Zhang W, Chiong R. ELITE: a novel approach of knowledge integration in pre-trained language models for text classification. Appl Intell, 2025; 55(16): 1088 (2025).
17. Goffman, E. The Presentation of Self in Everyday Life. New York: Anchor Books; 1959.
18. Mendez A, Mendez J, Baglio M. The Moscow Rules: The Secret CIA Tactics That Helped America Win the Cold War. New York: Doubleday; 2019.
19. Hoffman D. The Billion Dollar Spy: A True Story of Cold War Espionage and Betrayal. New York: Anchor Books; 2015.
