While clinical guidelines are the norm in medicine these days, most of us recognize they are merely just that—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. One such example would be a patient with known CKD who complains of difficulty sleeping, weight loss, or poor appetite.
Unfortunately, most insurance companies place no value on this instinct and will routinely deny tests outside the routine pathways.
What Should We Do When This Instinct Kicks In?
› Recognize it for what it is. It is an instinct formed from countless past encounters.
› Follow your instinct. Don’t give up if tests indicate no problem but your “spidey sense” is still on high alert.
› Fight insurance denials. These are often automatic. File appeals when possible.
› Do your own research. There are likely hundreds of studies regarding whatever you are suspecting.
› Answer patient’s questions honestly.
It is very frustrating to be unable to find an accurate diagnosis. Imagine what it must be like for the patient. They are scared, frustrated, and likely have little idea what is happening. 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.
It is also important to remember that clinical pathways exist as a tool to help us diagnose and treat patients. However, diseases don’t know these pathways, or what is written inmedical 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, patients often have more than one disease. Established guidelines don’t usually account for alternative routes with multiple diseases.
Medical knowledge is advancing at amazing speeds, and guidelines are important and necessary, 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.
