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When Doctors "Just Know"


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When Doctors "Just Know"

By William Berry, MD, CRICO

Related to: Ambulatory, Diagnosis, Documentation, Emergency Medicine, Primary Care, Obstetrics, Other Specialties, Surgery

Physicians make clinical decisions every day, using scientific knowledge and practical experience, carefully balancing the hard information with the “soft”— those things that are difficult or impossible to measure and do not show up on a CT scan or in a lab test. This necessary balancing demonstrates what is widely known and understood—that the practice of medicine is complex—part science and part art. The result is often a feeling, intuition, or instinct that reflects the total information available in a given case. When you have been in practice a few years, you can often tell whether a patient is sick or not from across the room, or just by looking into someone’s eyes or feeling a pulse.

Those instincts are not to be taken lightly in medicine, for they reflect the integration of very subtle observations, many years of training, and sometimes subconscious thought processes. There are times you “just know” that the child with a fever doesn’t have a simple otitis media, or that the “lump” that you see isn’t just a lump. How do you know? You probably can’t even put it into words, you just know.

When you have those feelings, it is often time to ask for the opinion of another physician. If you are still worried after the specialist sees the patient, if you just know that what you see isn’t right, and are not fully satisfied with the recommendations, don’t let go until you are satisfied with the explanation. Ask for another opinion if you have to. As many of us have found with standardized tests, your first impression—if well informed and carefully considered—should at least be held until another diagnosis satisfies you. If you are the patient’s primary care physician, nothing precludes you from following and observing something yourself that you feel is abnormal. Remember to carefully document what you see, so that changes over time become evident to you.

Patients are not the only ones who should ask for a second opinion. You can, too. Your patients will benefit when you listen to your instincts.

March 1, 2007
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