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Instincts vs. facts: How one physician learned to listen to intuition

In an essay for The New England Journal of Medicine, a Stanford resident writes about trusting intuition when a patient needs more than medical facts.

How does a doctor hone his intuition?

Thomas Yang Sun, MD, a Stanford internal medicine resident, discusses this intangible art in an essay published in The New England Journal of Medicine.

His intuition had been wrong before. He reflects on one patient whose pain, he incorrectly thought, was psychological in origin. For another patient, he had prescribed opiates, only to see that patient leave the hospital after discovering a shortage of the IV medication.

“With patient after patient,” Sun writes, “I align and realign my inner compass, shifting it in divergent directions, sometimes in the end pointing myself back to where I started.”

His journey brings him to the case of a fragile woman in her 80s, an avid gardener “with a type of breast cancer that spread like the weeds she wrestled with, while she wore a wide-brimmed hat under the sun.”

On her 14th day in the hospital, he can tell the patient is in pain, from the way her legs are half-drawn up to her chest. She is fighting back tears.

With help from Sun, the patient calls her daughter, who is moments from embarking on an anniversary vacation trip that will make her unreachable for days.

The daughter asks Sun, “Should I come now you think, or…?”

Knowing that the patient isn’t dying at that time, he struggles to make the judgment call. The moment is pivotal for his development as a physician. He writes:

For a while, I wasn’t sure how I could develop sharper instincts for situations in which medical facts fail to inform value judgments. But now, faced with this woman in pain, I realize that there can be some precious, rare moments when an inner voice speaks so strongly that it catches one by surprise. When it does speak, I now know to listen and follow.

In this case, Sun's intuition told him that the patient needed her daughter by her side. After hesitating, he found his voice.

Photo by StockSnap

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