Momwithastethoscope's Weblog

September 26, 2009

Loving Pediatric Medicine – the anti-rant

Filed under: pediatrics,positive medicine,Synchronicities — momwithastethoscope @ 4:14 pm
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Reason Number 26:  Intuition. 

It is always with excitement that I wake up in the morning wondering what my intuition will toss up to me, like gifts from the sea. I work with it and rely on it. It’s my partner.” Dr. Jonas Salk 

 For some patient encounters, evidence-based, rooted –in- science medicine doesn’t answer all the questions.  It is during these times that I rely on my silent consultant, intuition.  My logical mind would like to resist these encounters, but an intuitive “hit” is like IV caffeine to the rest of my brain.  And like Dr. Salk said, “Intuition will tell the thinking mind where to look next.”

A-ha moments are born of intuitive hits.   Early in my career, I diagnosed a sweet, eight year old with leukemia.  She was pale and appeared ill, but she could have looked that way for a number of reasons.  Even the oncologist I referred this patient to noted that she could be sick from a wicked viral infection.   A bone marrow biopsy confirmed the diagnosis that I had suspected before her blood count came back.  This patient’s mother came to me one day after her daughter was treated and in remission and asked me how I knew that her daughter had leukemia.  I didn’t have a good answer – leukemia is one of those illnesses a general pediatrician will see lots of in residency but very few in private practice. (Fortunately!)

Most hunches about my patients and their families are not this extreme.  I use this radar to strike a balance between what parent’s desire from a medical encounter and what’s called for depending on the complaint.   Disharmony in families will lead to visits to my office.  While surveys such as those used by Mary Caserta, MD and Peter Wyman PhD in their research connecting childhood illness to family stress are used in controlled settings, I have found that my own intuition is a good barometer.  Sometimes I’m the tie-breaker is a difference of opinion between spouses or other family members.  Sometimes those “oh-by-the-way” hand on the door moments are parents reaching out for a sounding board. 

Maybe intuition is just accumulating experience, but I doubt it.  Hunches and gut feelings remind me that I’m not in this medicine business by myself – that some other force is at work as I navigate my way through the lives of my patients.

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