A fascinating article in the New York Times about nurses’
“gut feelings,”makes the argument that:
Every nurse likely knows the feeling. The patient’s vital signs are just a little off, she seems not quite herself, her breathing is slightly more labored. But on paper she looks stable, so it’s hard to get a doctor to listen, much less act.
In such situations nurses invoke “gut feelings,” but they actually aren’t feelings at all — they are agglomerations of observations and experiences that over time have turned into finely tuned clinical judgment. The idea is that working at the bedside has honed nurses’ perceptions to be especially alert to brewing trouble.
The article goes on to describe software that aggregates data to help predict problems and support the intuitions described above:
Together the Rothman brothers came up with the Rothman Index, a commercial product that uses data from standard electronic health records — including lab values, vital signs, cardiac rhythms and key aspects of nursing assessments — to monitor hospital patients. It tracks their status as a graph that falls into a blue, yellow or red zone, based on whether they are at low, medium or high risk of an acute event.
While this sounds like a great idea, lets not also lose touch with the value of the intuition — and extend the exploration and valuing to family members and indeed the patient themselves. I suspect that we could “train” patients and families to be much more mindful about patient monitoring, including how to trust their instincts and how to communicate their feelings to the medical personal. This, of course, should be accompanied by training of medical staff on how to take the most advantage of, and how to solicit such communications. It is not hard to construct model ways of doing so.
I suspect that just like the nurse who wrote the article felt badly about a situation in which they had failed to communicate their instincts about a patients decline, many family members worry for the rest of their lives that if they had shared their own intuitions, there might have been a better outcome. (Actually, that’s not a hard question to survey — self-reporting would be meaningful in itself.)