Gut Feelings

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,

Dr Nick

Disappointment, Grace Jones and The Reality Check Needed

This week has been a cracker in GP. I have seen such a melting-point of conditions that I am have never been bored; from otitis media (that’s a middle ear infection) which I managed to diagnose based on the patient’s symptoms and (more excitingly) the bubbles of fluid I saw the other side of her ear drum – a first for me, to the young teenager who I am pretty sure may have something known as slipped upper femoral epiphysis (known lovingly as ‘SUFE’), in which there is slippage at the growth plate in the long bones of the legs. Now this was interesting because I saw this teen the day before and his symptoms were fairly non-specific so I initially attributed them to simple growing pains – but at 3am that night, I woke up and couldn’t shake the fact that SUFE can be so easily missed that I didn’t want to chance it. I arranged the hip x-rays for him the next day. You have to act on your gut sometimes, I’m learning in medicine, even if it turns out to a false alarm.

So, yes, all in all a good week for me. However, that’s not what I really wanted to talk about in this week’s blog. This week I want to talk about disappointment and some re-grounding that I expect was needed for me. So for those of you who have perhaps just started reading my blog, I will just contextualise this a little for you. I, as a very junior doctor had some opportunities to be on a television programme about medicine. I jumped at the chance – simply because I love talking about health – and, yes, it was exciting! I have spoken about it a few times on my blog over the months if you ever want to track back and see the beginnings of how it came about.

This week however, the bubble was somewhat unceremoniously ‘popped’. Firstly, on Monday I learned that a VIP invitation that I had received to Grace Jones’s concert and dinner at Annabelle’s in London (a very swanky club that even my mum and nana remember!) with a host of celebrities, was indeed a mistake. It turns out that they thought they were inviting Nick Knight the famous fashion photographer!!! When I received the call telling me this (having of course told mum, invited someone very special to be my plus one, bought a fancy new tie and got my suit dry-cleaned), I have to say I did laugh! It was funny because I couldn’t shake the feeling that it was a bit odd…I mean seriously, why would I have been invited! Still, at least I avoided some horrendously awkward chat if I had actually attended – sporting a complete look of confusion as they tell me that they “love my work”…as I reply with “well, I just prescribe antibiotics, really”…! Needless to say when I told my mum she couldn’t help but cry with laughter. It was funny and I must admit when I opened the papers the day after the event to see Kate Moss stumbling out of the gig and Harry Styles with his shirt has off (or is that the style, I’d don’t know….), I did feel quietly relieved – that’s really not my scene. I smile as the whole scenario reminds me of when I mistakenly received an email from an Expedition Medicine company I used to work for who asked me to come out to the jungle to help teach the jungle course in Costa Rica. Of course, as a final year medical student at the time, I though that was a little ambitious! Turns out I was right, the email was meant to go to “Former Special Forces Doctor Nick”! At least I hadn’t booked the plane tickets…

So that was wake up call number one. Number two was when I learned that the television show I was on, and was being aired currently…has been taken off air. Turns out I may be too ugly for TV! Haha, no sadly, although that may be true, the fact was that the show was not performing and unsuitable for the prime time slot. It may well see itself on in a different slot…but I remain to be convinced of that. It was disappointing but I can take huge positives from the experience – including most importantly how I want to reflect myself as a doctor on screen (if I were to ever appear again). I also learned, even from this brief initial flutter with television that I need to develop a bit of a thicker skin when the people I know discover it and well, are not always positive. Criticism is something I have naturally never coped with well and I guess, at 31, maybe it is time to start working on that.

So two wake up calls this week. It hasn’t for a moment dampened my hunger to see if I can combine medicine and media – again, all for the simple reasons that I love talking about medicine and health – it touches us all in so many different ways, after all. However, while the slow wheels of media churn away, perhaps throwing up another opportunity in the future, I am very very happy. Currently I am having a bit of a love affair with medicine – I am enjoying being a doctor, made curious by my patients, am excited for a future in general practice – and, dare I say it, even looking forward to how much I will see and learning in the Emergency Department from December to March (even though that means working every one in two weekends!). The applications to General Practice training scheme opens next week so I am eager to get that submitted and start working towards the selection exam. Hmmm exam – sounds dull – but actually it is a great excuse to better my clinical skills even more…and the way that I am feeling right now – well, that’s no chore. Nothing is when you are passionate about it.

I hope you all enjoyed a particularly creepy Halloween as well!

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(My attempt on a quiet Friday Halloween eve!)

Have a great week everyone and try to fight any Seasonal Affective Disorder creeping into your days.

Dr Nick