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Caregivers’ tacit knowledge (TK) involves interpreting non-verbal signals, yet physicians may find it hard to receive and convey. Semi-structured interviews with 10 intellectual disability physicians were analyzed thematically to reveal perceptions and valuation of caregivers’ TK. 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Huisman 1,2, *, Kasper Kruithof 3, Maartje Hoogsteyns 3, Appolonia M. Nieuwenhuijse 3, Dick L. Willems 3 and Ilse H. Zaal-Schuller 1,2  \nAcademic Editors: Jereme D. Wilroy and Yumi Kim  \nReceived: 22 October 2025  \nRevised: 12 December 2025  \nAccepted: 15 December 2025  \nPublished: 22 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Paediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands  \n2 Zodiak, Prinsenstichting, Kwadijkerpark 8, 1444 JE Purmerend, The Netherlands  \n3 Department of Ethics, Law & Humanities, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands  \n* Correspondence: [s.a.huisman@amsterdamumc.nl](s.a.huisman@amsterdamumc.nl)  \nHighlights  \nWhat are the main findings?  \n• People with profound intellectual and multiple disabilities (PIMD) express pain and discomfort through non-verbal signs and depend on caregivers’ readings and interpretations of these signs.  \n• Caregivers’ tacit knowledge (TK) refers to a crucial ability for recognizing these subtle signs and irregularities or for sensing when something is wrong, which are typically difficult to communicate with physicians.  \nWhat are the implications of the main findings?  \n• Caregivers’ TK is essential for physicians, as it provides valuable diagnostic cues and helps start a joint diagnostic process.  \n• Medical care in co-production with caregivers depends on trust and partnership to overcome communication barriers and improve the physical and mental well-being of people with PIMD.  \nAbstract  \nBackground: Diagnosing physical and mental health issues in individuals with profound intellectual and multiple disabilities (PIMD) often proves challenging, as these patients are unable to speak for themselves. Caregivers’ tacit knowledge (TK) refers to interpreting non-verbal signs, and is difficult to communicate with physicians. As limited research existson physicians’ perspectives, we aimed to explore how intellectual disability physicians (ID physicians) perceive and value caregivers’ TK. Methods: Semi-structured interviews with ID physicians (n = 10), focusing on their perceptions and experiences with caregivers’ TKin medical care for people with PIMD, were analyzed thematically with an interpretive approach to identify key patterns and insights. Results: ID physicians perceived caregivers’TK as a critical ability to pick up subtle signs and irregularities or as a deep sensing something is wrong, with the latter being more difficult to communicate. They understood the importance of TK for diagnostic cues and of collaborative relationships to explicate TK. Conclusions: We describe how integrating caregivers’ TK with medical knowledge relies on trust and partnership. Moreover, we discuss how to overcome communication barriers and to improve medical care in co-production with caregivers in order to enhance the physical and mental well-being of people with PIMD.  \nKeywords: tacit knowledge; profound intellectual and multiple disabilities; caregiving; disability health; inclusive healthcare; intellectual disability physicians; health communication; health promotion; knowledge mobilization  \n1. Introduction  \n‘There is something different about my daughter: I sense something is wrong with her, and I’m so worried, doctor!’ Diagnosing physical and mental health issues in individuals with profound intellectual and multiple disabilities (PIMD) often proves challenging, as these patients are unable to provide an anamnesis. People with PIMD, characterized by an estimated IQ below 25, sensory impairments, and severe motor disabilities, express pleasure, pai","cbCaip4do5IdVcVe","https://ap.wps.com/l/cbCaip4do5IdVcVe","pdf",993401,16,"English","# Highlights\n## Main findings\n## Implications of the main findings\n# Abstract\n# Keywords\n# 1. Introduction\n# 2. Methods\n## 2.1. Study Design\n## 2.2. Researchers’ Positionality","[{\"question\":\"Why is diagnosing health issues in PIMD often challenging?\",\"answer\":\"People with PIMD are unable to provide an anamnesis, so physical and mental issues must be inferred from non-verbal signs rather than spoken accounts.\"},{\"question\":\"What does caregivers’ tacit knowledge (TK) mean in this study?\",\"answer\":\"TK is a personalized ability to recognize subtle signs and irregularities—often described as sensing when something is wrong—based on repeated intimate interactions, yet difficult to explain to physicians.\"},{\"question\":\"How do physicians integrate caregivers’ TK into medical care?\",\"answer\":\"Physicians view TK as providing crucial diagnostic cues and emphasize that integrating it depends on trust and partnership to explicate TK and manage communication barriers in co-production care.\"}]","From Hidden Insights to Better Understanding - Physicians’ Perspectives on Caregivers’ Tacit Knowledge | PDF",1790763721]