Sick or Not Sick? The Healthcare Provider’s Sixth Sense

I wrote the following today on my scrap paper after learning of the story of the tragic death of the young boy, Lewis. The factor that most struck me regarding his death was the failure of the junior team members to recognize that something was wrong over the weekend. It led me to the following reflection:

The scariest part of my surgery rotation as a third year medical student was taking weekend call. It was me, an intern, and a junior resident – usually a PGY 2 covering the entire floor and everyone walking through the ER door. Not one of the three of us had enough clinical experience to have yet developed that sixth sense that helps you tell if someone is “sick” or “not-so-sick.” A good attending physician can look at a patient from across the room and know that something is wrong, but that skill comes with experience, which none of us had. How many people had only subtle signs of illness that we missed and failed to recognize as “sick”? Lewis had subtle signs and probably looked sick, but none of the residents caught what an attending likely would not have missed.

In the end, I think it is great that we now feel more comfortable calling our chief residents and attendings on weekends or in the middle of the night, but in a case like Lewis’s would we have even thought to call? Would we have even recognized that something was wrong? In the ER, you never put your newest nurse on triage, so why on surgery were the most junior team members the ones left triaging what information was relayed to the more senior physicians? Until residents develop the ability to get a good general impression of the patient, no patient should stay in the hospital without an attending examining them.