My medical student was presenting the patient’s history to me. It was quite an extensive and well taken history.
I told my student, “He is just here for a school note”.
We went in the room together and talked to and examined the patient. After we reassured him that his 3 days of diarrhea was a benign self-limited virus, the question popped out asking for the note. My student was awed that I predicted that but it is something that just develops with experience.There are times when a doctor just feels there is something wrong with a patient, despite clinical indicators. Insurance companies possess rigid guidelines concerning what diagnostic tests and medications they will cover. Is there room for a doctor’s sixth sense in medicine?
I would say yes and I witnessed this played out many times over my career, not just with myself but other doctors as well. Recently, a woman came to me feeling tired. She had no other complaints. Normally, I would just work her up for fatigue but she just didn’t look right to me. There was nothing on physical exam that was alarming. Despite the fact that her only complaint was fatigue, I decided to send her to the ER based on my 6th sense. Later that day, while in the ER, she suffered a massive heart attack. If it had occurred while she was at home, she would have probably died.
Where does this 6th sense originate? Doctors see many patients and develop a sense of what a disease state looks like. And it often doesn’t present like it does in the medical text books. This is part of the clinical acumen that we develop after treating countless patients and learning to be diagnosticians. This is not a skill that can be taught or learned. It is not something that can be explained to an insurance company clerk when battling to get a test covered that a patient needs. It is just something that is. And all doctors, nurses, and other healthcare workers develop some degree of it over time.
Medicine is not just a science but an art as well. Not every doctor does treats diseases the same way and that is okay. There are often several approaches that work equally well. And the healthcare community complements each other well when we draw from the senses of all involved for the good of our patients. Yet,insurance companies and other 3rd parties don’t see this but rather strict guidelines that must be obeyed. Medicine doesn’t work that way. No 2 patients are the same. No type 2 diabetic patients are the same. We need to individualize our care and force our patients along clinical pathways.
The push now is to pay for good clinical outcomes. Those devising the targets are looking at only data and numbers. If a patient does to reach a certain LDL level or HBA1C, I will be paid less. Doesn’t matter if I convinced that patient to quit smoking or I spent an hour comforting them because their parent just died.
The system is moving towards “big data” and I disagree. I say we restore the art back to medicine and put the individual back in the patient. Assembly line standardized medicine needs to end. Doctors cannot our 6th senses any longer. Patients’ lives are at stake.
Copyright secured by Digiprove © 2015 Linda Girgis, MD, FAAFP
