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Go With Your Gut

I had dinner with a physician friend of mine who works in New York City. She told me an interesting story about her last couple of days at work…

A patient of hers was in the hospital on a fairly high dose of steroids to treat an autoimmune disorder. He was generally a very even tempered and friendly person, but was a little bit grumpy when she visited him on rounds that evening. He was complaining of slight shortness of breath and some mild stomach pain – and that the hospital food was bad. His labs from that morning were all normal, and he had no fever or abnormalities in blood pressure or heart rate.

On sheer gut instinct, my friend ordered a CT scan of his abdomen right away. Lucky she did, because this gentleman had a perforated colon (from ruptured diverticulae) with air under his diaphragm, causing shortness of breath. Because he was on steroids, the body’s usual response to early sepsis was blunted. He was rushed to the OR where surgeons corrected the problem. In this situation, if it weren’t for a gut instinct, this patient may have died.

I think this case illustrates how important it is to know your patients, to take their concerns seriously (especially when they’re on medicines that could minimize serious symptoms), and if something doesn’t seem right (even if lab tests and vital signs argue otherwise) you should listen to your gut. Sometimes instinct is smarter than science.This post originally appeared on Dr. Val’s blog at

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