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‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

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11–20 of 75 posts

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#11
post #7
post #3

Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic. Also of tremendous import is "gut feeling" which is called out specifically in the article: "Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why." The disorganized, indescribable, cumulative knowledge of a human practitioner w…

I work with a lot of physician colleagues (as well as veterinarians) and one of the things I wish we could capture was what words someone uses to trigger those gut feelings. The way a patient describes their pain, how we try to wrap our language around complex disease concepts...

If you are focusing on words, you are missing the big picture. 'Guts feelings' are what you get when your brain process a butt load of informations in a fuzzy way. This includes subtle smells, colors, moves, timing, shapes, sounds, chain of events and how they interact with each others.

Words can be a tiny part of it, but usually gut feelings are about all those things you can't process as easily with rational thinking and so rely on a different, less precise and more general, method of analyzing. This does not play well with language, which is very accurate and precise, very intellectual.

It's why we can easily walk, but have a hard time describing how we walk.

A commenter on HN talked about the book "The inner game of tennis" not so long ago. I highly recommend it to get a gentle introduction to this part of us. Especially on this site, where a lot of us are geeks who are more used to leverage their rational thinking than their feelings.

Last year, many commenters talked about meditation. While I do recommend the practice, starting from the sport point of view is way easier to swallow and make a better starting point for people with strong affinity with precision and step by step logic.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#12
post #4

As a non medical professional, I can't even imagine the difficulty in trying to diagnose a severely sick child that is too young to speak or articular symptoms/where it hurts... Scary.

Also, 'fever and a bit of a rash' are the symptoms of just about every childhood illness ever, and perfectly harmless 99% of the time and fatal within 24 hours 0.1% of the time (or something).

Every few years you get some indignant news story banging on about how some awful hospital sent a poor sick child (presenting with fever and a rash) home with some Panadol instead of ordering a full battery of tests, and then the child turned out to have meningitis or something.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#13
post #9
post #4

As a non medical professional, I can't even imagine the difficulty in trying to diagnose a severely sick child that is too young to speak or articular symptoms/where it hurts... Scary.

One of the things my veterinarian colleagues talk about a lot is how do you make a diagnosis with "My chicken is acting funny" as the only information you have.

"My car's making a funny noise."

"My computer's acting weird."

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#14
I think another solution is forcing doctors to work more off of check lists and less following their gut.

When I was a baby I also had some weird symptoms and my mother took to be several pediatricians who couldn't identify the problem. Eventually one evening my mother ended up in the emergency room with me and got to see a really nervous young doctor who, as my mother describes it, it felt like we where the first patients he'd ever seen on his own. Anyway this 'kid' literally had a folder with lecture notes on his desk and worked through them step by step and ordered the right tests and nailed the diagnosis on his first try (which fortunately turned out to be nothing serious).

So as much as it's vital for parents to follow their gut, I feel like doctors often just follow their gut far too much and need to take a more rigorous approach to diagnostics.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#15
post #3

Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic. Also of tremendous import is "gut feeling" which is called out specifically in the article: "Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why." The disorganized, indescribable, cumulative knowledge of a human practitioner w…

> The disorganized, indescribable, cumulative knowledge of a human practitioner who has seen thousands of cases is so valuable that it should be given very particular nomenclature and afforded tremendous esteem

“Clinician gestalt.” Non-inferior to almost every clinical decision rule we’ve tested, or otherwise incorporated therein (eg, Wells’ “most likely diagnosis” criterion).

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#16
post #13
post #9

Earlier quoted context omitted.

One of the things my veterinarian colleagues talk about a lot is how do you make a diagnosis with "My chicken is acting funny" as the only information you have.

"My car's making a funny noise." "My computer's acting weird."

But you can't take apart or reboot the chicken.

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#17
post #7

Earlier quoted context omitted.

I work with a lot of physician colleagues (as well as veterinarians) and one of the things I wish we could capture was what words someone uses to trigger those gut feelings. The way a patient describes their pain, how we try to wrap our language around complex disease concepts...

If you are focusing on words, you are missing the big picture. 'Guts feelings' are what you get when your brain process a butt load of informations in a fuzzy way. This includes subtle smells, colors, moves, timing, shapes, sounds, chain of events and how they interact with each others. Words can be a tiny part of it, but usually gut feelings are about all those things you can't process as easily with rational thinki…

The gut feelings a health care professional gets will vary based on the language the patient uses.

The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#18
post #13
post #9

Earlier quoted context omitted.

One of the things my veterinarian colleagues talk about a lot is how do you make a diagnosis with "My chicken is acting funny" as the only information you have.

"My car's making a funny noise." "My computer's acting weird."

You forgot: "It's not working!"

Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics

#20
post #17

Earlier quoted context omitted.

If you are focusing on words, you are missing the big picture. 'Guts feelings' are what you get when your brain process a butt load of informations in a fuzzy way. This includes subtle smells, colors, moves, timing, shapes, sounds, chain of events and how they interact with each others. Words can be a tiny part of it, but usually gut feelings are about all those things you can't process as easily with rational thinki…

The gut feelings a health care professional gets will vary based on the language the patient uses. The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".

Your example perhaps doesn’t lend itself to a discussion of “gut feelings”, since it describes different symptoms quite specifically. In the absence of other information, the first sounds like a heart attack, the second, heart-burn (acid reflux).

Gut feeling relies on more abstract concepts, particularly in the context of pediatrics where a child may be unable to verbalise their symptoms.

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