How reliable is a patient's gut instinct?

Posted by on 30 May, 2009

The ultimate doctor - Doug Ross

Yesterday at work I saw two patients that got me thinking about gut instinct.

Terri’s story is quite amazing. She had a typical gastro virus a month or so ago but three days after she stopped driving the porcelain bus she didn’t feel good. That was about the extent of her symptoms. She went of to the doctor where she put her case forward that something was not right. She argued she normally felt fine after a virus but this time she hadn’t bounced back as she thought she should have.

After a bit of a push, her doctor ran a serious batch of blood tests and lo and behold something indeed was not right. She has a high ca125 blood test, which can be a red flag for ovarian cancer. In her case it turned out to be (the far less abysmal) cervical cancer and she will start chemotherapy next week. But it is limited to her cervix and hadn’t spread because they caught it early enough. Because both she and her doctor trusted her gut instinct.

Unlike another patient I just an hour later. Beth had headaches for over a year but her doctor wasn’t overly concerned about that. She was reassured that the headaches were due to tension and was given some neck exercises. Until one night when she had a seizure and a CT scan of her brain found the headache causing brain tumour. Beth had trusted her doctor more than her own gut instinct.

So sitting there in my surgery hearing these stories, it just made me wonder; would I have run those tests? Do doctors - and should doctors trust a patient’s gut instinct?

The answer is both yes and no. In Terri’s case, being prepared to back herself has probably saved her life. And I know trusting her patient’s gut instinct will have saved her GP a lot of sleepless nights.

But patients don’t always get it right. There is a condition known as somatization disorder. We think somatizers are so in touch with their bodies that they feel every movement through their bowel, every hormonal surge etc acutely and concentrate so hard on these that they are sure they are signs of terrible disease. Somatizers often end up having a plethora of normal tests and are never quite satisfied with the outcomes.

But those tests cost money. Money that tax payers have to provide. Every CT scan, every weird and whacky blood test, every trip to a specialist attracts a Medicare rebate and we are all footing the bill for that. Should doctors be service providers for clients and agree to run any test that is requested of them? Or should we be gatekeepers of the public purse and insist on only ordering tests that are likely to yield a result?

Late in the same afternoon, I saw another patient whose gut instinct was totally off. She had come to me a few days ago with a cough that was lingering after a cold. Common enough, right? She certainly wasn’t worried at all. It was her husband who insisted she come in to see me. But my gut instinct went off. I insisted she go straight up the road for a chest XRay. Yesterday we were arranging trips to the local cancer centre to have her newly diagnosed cancer dealt with. It shows not only that terrible things can happen to the very nicest people and that being a doctor can suck sometimes but is further proof that  a patient’s gut instinct can’t always be trusted.

I’d love to hear your thoughts and experiences….. drop me a line!

* All names have been changed- of course