The Voices in Your Head

I had this attending my intern year who would always send us in to see a patient and then ask, when we came out of the room, "sick or not sick?". I spent my 3 years of residency honing that skill, that gut feeling supported by experience and clinical knowledge, which allows me to assess a patient within minutes (sometimes seconds) as perhaps someone who needs more critical care than I can provide. To this day, I ask myself "sick or not sick" anytime I see a patient on the floor.

I had the opportunity to listen to this voice last week. Another physician from a hospital a couple hours away transferred a patient to me billed as more puzzling than anything. They had run multiple tests and thought they had a diagnosis and were ready to discharge her when her symptoms returned and gave them pause. I accepted the transfer and proceeded to wait for her arrival to the floor. However, there was something nagging at me. Something about the story was troubling me but I tried to reassure myself. After all, she had already been in the care of another physician who I'm sure has more experience than me. Surely they would have noticed and ruled out the very things that were scrabbling around my brain and causing me to have my 'nervous stomach'. Right??

As tends to happen on a Friday afternoon when the residents are all at lecture and I am finishing my first week on service...I walk into the room as soon as she arrives and my 'gut voice' is screaming "sick! sick! everything you thought was going on IS going on!". My gut voice doesn't have much tact, but she is phenomenally insightful. I'm learning that I should really listen to her more often. Thankfully, I had the support of the critical care team and specialists right away and she was taken to the critical care unit, where she remains today. Looking back, I should have been more focused and skeptical in my questioning of this other physician. I should have trusted my instincts and told the ICU about the patient and my suspicions before she ever arrived. As a young and fairly green hospitalist, I am quick to defer to others' judgment. This experience taught me that I can and should rely on my clinical assessment. I may not always make the right diagnosis right off the bat, but I can tell sick from not sick and that is the first step. Now I'm the attending who sends my interns into a room and asks "sick or not sick?".