It is interesting, the notion of a gut feeling. I searched online to find a definition this morning (don’t worry, no patient neglect – a week of annual leave), and found this: “an instinct or intuition; an immediate or basic feeling or reaction without a logical rationale”. We all experience gut feelings from time to time. Some ignore them, some never realise they are present, and some act on them with an almost religious vigour. The rest, including me, pick and choose when to act upon them – with some gut feelings stronger than others. Hollywood loves a gut feeling – often some hero or heroine making the improbably ‘call’ and saving the day.
Like in medicine is definitely less ‘Hollywood’ than this. Yet this week I have found myself relying on my gut feeling quite a lot. Amongst the string of viral colds, muscular aches and sprains, and medication reviews I came across three patients whom I was on the fence clinically – that is do them need further investigations urgently or sending straight into accident and emergency. As a result of sitting on the fence clinically, which is based on my albeit limited clinical experience to date, I turned to how I felt about the patient – what my gut feeling was.
Now to digress just briefly – in medicine, you have gut feelings all the time. As a ward based doctor before I went into my general practice rotations, I experienced them a lot. It is classically the ‘end of the bed test’; This is where you will quite simply look at the patient from the end of the bed and they just don’t look right – or they look different from yesterday – just something, something you can’t put your finger on, and that the vital sign observations do not reveal. You have probably experienced these at work, with family or when out and about – you look at someone, something, or a situation unfolding and your gut tells you it’s not comfortable and you need to alter what you were about to do. I am sure, in medicine, as we doctors gain more experience, that this gut feeling becomes better trained and more refined. It’s the skill that medical school, like breaking bad news of a death, just cannot teach you in real life clinical practice.
So back to my three patients in GP surgery this week – The first two were both children both under the age of 2 years (one was just 10 weeks old). They both had non-specific symptoms, a bit of a temperature but not much – but then mum was on antibiotics for a bacterial chest infection – and when I looked at these little ones, they just looked a bit drowsy, a bit too pasty – and the whole story just didn’t feel right. When I examined them (these are two separate cases by the way), both didn’t reveal anything floridly alarming, perhaps a few added crackles to their tiny chests, the 10 week olds of which was no bigger than the palm of my hand – my stethoscope was huge when compared to her tiny frame. Not happy, I picked up the phone, and for both discussed the cases with the local on-call paediatric registrar. Both conversations resulted in the same outcome – both patients were transferred to A&E for speciality clinical reviews. I am still awaiting the discharge letters to see what happened to them.
The third patient was a little different – a man in his 50s. He came to me with a sore throat. Now in cold and flu season this is not an uncommon presentation. When, however I looked at him, he had yellow (referred to as ‘jaundiced’) eyes that indicated potentially a degree of liver disease, and when I examined him mouth and throat he had thrush. Oral thrush in a 50+ year old man is not common. In fact, it is a worrying sign. My gut was telling me that something very bad may be going on with this patient. On further discussion he had lost weight (not deliberately), coughed up blood in the past, smoked a pack of cigarettes a day for as long as he can remember, and drank to dangerous excess. When I sat in front of this patient, my gut said this is a serious case, and once I had that clinical information it only confirmed my gut. This gentleman was sent urgently for specialty review under the cancer two week wait rule.
So there we have it, a week of being more aware of my gut than usual. It is a wonderful, unexplainable tool that we all possess. Sometimes it works well for us, sometimes it works against us. This week, mine had been an ally that’s for sure.
Have a great week everyone,