Medical intuition is a hard-won ability. Further, because although you may have this ‘second-sight’ to some degree, you can still make mistakes [take it from me!] Intuition, I guess, means that all the facts might lead you to one logical conclusion while intuition raises a cautionary finger and whispers, “Not so fast.”
This ‘sixth sense’ can only come with years of experience and study, and is a peculiar mix of knowledge, clinical exposure, and some other ability which defies explanation.
During my years of practice, as best I recall, I had two episodes which bear on this topic.
One day, I stood in the Doctors’ Room, and watched a pale, screaming young woman wheeled urgently down the hall complaining of severe abdominal pain. Another of my partners was due for that case; he started out the door. “Ruptured ectopic pregnancy,” I murmured, “She’s got the look.” My younger partner stared skeptically at me and raced off to her bedside.
An ectopic pregnancy grows large in the fallopian tube, not the uterus. Given the size constraints, there is only so much room for the ovum to grow before it bursts free of the tube’s enclosure. The induced bleeding is often torrential, fatal if not recognized and surgically treated.
My partner re-appeared looking stressed. “Lucky, I don’t know what she’s got, but it’s bad, and it’s surgical!” [It will require surgical remedy to save her life.]
“A ruptured ectopic,” I said again.
“Her pregnancy test is negative.”
This news rattled me a bit, but I couldn’t shake my intuition.
Short story: The young lady had surgery, and what was found? A ruptured ectopic…
She had had a false negative pregnancy test. The problem with testing is there are false positives – indicating you have a disease which in fact you do not; or a false negative which indicates you don’t have a condition, which in fact you do.
How did I know? Intuition. What does that mean? I don’t know…
He was in his twenties screaming of an epigastric burning [a discomfort high in the abdomen where your ribs separate.] He had no history of heart disease or conditions which might lend to a diagnosis of aortic dissection; but he had suffered several episodes of heartburn, but nothing like this.
My tail feathers were up; something serious was going on here, and that something was trying to fake me out.
I ordered nitroglycerin and aspirin.
“For heartburn?!”
“I’ve just got a feeling.”
Repeated EKG’s and cardiac testing were negative, – in fact, all testing was negative – and the pain was worse. I ordered serial EKG’s, one after the other. My staff thought I had lost my mind.
The sixth EKG was positive; a huge coronary! In no time, he was in the cath lab and the blockage was alleviated by hands more capable than mine.
How did I know? Intuition. What does that mean? I don’t know…
