While clinical guidelines are the norm in medicine these days, most of us recognize that these are merely for guidance and can’t eliminate gut instinct. Sometimes, we see a patient and just know there is something not right. Their tests may say something different, but our years of clinical experience have honed our sixth sense. There is no pathway for this acumen. Despite doctors developing this instinct, most insurance companies place no value on it and routinely deny tests if they fall outside the well-developed pathways.

What to do when our gut instinct kicks in?

  • Recognize it for what it is. It is an instinct that was formed from countless past encounters with patients.
  • Follow your instinct. Don’t give up if the tests seem to indicate no problem but your “spidey sense” is still on high alert.
  • Try to recall similar patients.
  • Get help. Send the patient to a specialist if you think there is something wrong but cannot find the answer despite doing everything you can.
  • Fight insurance denials. These are often done automatically by following clinical pathways without any regard to medical acumen. File appeals when possible.
  • Do your own research. There are likely hundreds of studies regarding whatever you are suspecting. See what the studies found.
  • Remind yourself of what the patient is experiencing.
  • If you don’t have an answer, it is OK to say that you don’t know.
  • Answer patient’s questions honestly. For example, if you think the patient needs a certain diagnostic test but the insurance company won’t cover it, let them know you still think they need the test. Let them advocate on their own behalf as well.

It is very frustrating to be unable to find an accurate diagnosis for a patient’s condition. Imagine what it must be like for the patient. They are scared, frustrated, and likely have little idea what is happening to them. They are putting their trust in us to help them. We need to reassure them that we are doing everything in our power to find an answer. To give up on the search is to leave the patient without hope.

Follow the Patient’s Course

It is also important to remember that clinical pathways exist just to be a tool to help us diagnose and treat our patients. However, diseases don’t know these pathways or what is written in medical textbooks and often deviate from these avenues as they progress. We need to follow the course our patient is taking rather than try to shepherd them back onto the advised pathway.

Additionally, our patients often have more than one disease. Established guidelines don’t usually account for alternative routes with multiple diseases. Different medications may be needed in a patient who is diabetic, hypertensive, and smokes versus a patient who just has high blood pressure.

Medical knowledge is advancing at amazing speeds, and guidelines coming out of research are important and needed, but they can never replace the gut instinct. Clinical experience plays a very critical role; all the artificial intelligence in the world can never match it. Follow your gut instincts when they kick in.