Yes, yes, and yes.
A new study from the British Medical Journal found that doctors who trust their gut feelings when evaluating a sick child significantly helped the child. This is important because many children with serious infections have few clinical findings on examination. For instance, they don’t have a rash, an ear infection, obvious diarrhea, or abnormal lung findings. And because very young children often have few clinical findings, pediatricians always need to examine babies two months old and younger whenever they have a fever. The source of the fever can be hard to find and in babies, infections can spread very rapidly.
The study reported, “The clinicians’ gut feeling that the child was seriously ill considerably increased the chance that a severe infection was present… and heeding the feeling might have prevented two cases from being overlooked,” according to MedPage Today, an online medical journal. In my experience as a pediatrician, I can’t tell you the number of times I have looked at children who have no “signs” of infection but did not let them leave without testing. The reason is that after 27 years, I have learned to trust my gut feelings.
A few months ago, for instance, I had an 18-month-old boy in my office. When Caleb walked into the exam room, he was sitting on his mother’s lap with his head resting against her chest. He smiled weakly at me when I approached him. His mother told me that he wasn’t eating much, had a temperature, and “just wasn’t himself.”
As his mother and I talked she told me that for two days he had been less active, had a low-grade fever. Even though he wasn’t interested in eating his normal foods, he did eat a few things and drank some juice.
When I examined Caleb, the only thing wrong on his exam was a little belly tenderness. But something looked wrong to me in his demeanor and his facial expressions, so I asked him to walk into the hall with me. As he walked, I noticed that he tilted a little to the left as though something in his abdomen hurt.
From the findings alone, I could have sent him home with instructions to his mother to give him a liquid diet, watch for diarrhea, and take precautions that I give when kids have gastroenteritis. But something nagged at me and I told his mother that I wanted a CAT scan of his abdomen. I sent him to the hospital across the street and within two hours he was in a surgical suite being operated on for appendicitis.
This is not common in 18-month-old children. I would like to say that I was an unusually astute clinician, but I won’t. I simply trusted my gut. And I trusted Caleb’s mother’s gut feelings as well. Each of us knew that in spite of few symptoms, something was wrong.
So the next time you or your physician look at your child, look behind what you see with your eyes. Use your instincts because they usually don’t fail you. If you know that something is wrong with your child, make sure your pediatrician honors your instincts—and vice versa. If your doctor says that she feels something’s awry, in spite of how you feel, trust her. I doubt she’ll steer you wrong.
