Of all the things you learn in training, one of the most nebulous, but useful, is “Spidey Sense.”
In comics, Spider-Man had a power called Spidey Sense, which caused a skull-base tingling when danger was present. It was a prescient, clairvoyant ability that allowed him to take action to protect himself.
Somewhere along the line, most doctors I know get a similar ability, but it warns us when something is seriously wrong with a patient. Often, it fires before you even have a rational reason to be worried, and it’s almost never wrong.
As a senior in medical school, I heard a conversation between a resident and an attending. The resident was talking about how she’d seen a patient in the emergency department who she sent to the ICU without a concrete reason. An hour after arriving, the patient suffered a cardiac arrest and was successfully resuscitated. The attending told her that this was one of the most critical skills to develop: knowing when patients are really sick, even before you have any obvious reason to think they are.
I have no idea when I learned it. At some point it was just there. I assume it’s a result of years of medical training making you subconsciously recognize a bad situation. It doesn’t fire very often, but when it does it can’t be ignored. Sometimes even a few words typed on my schedule will set it off.
My staff knows when it’s hit me because I’ll bring an MRI order up to the front desk before I’ve completed the appointment and tell them to start working on it.
Not every sick patient sets it off. In fact, obviously sick people never do. In those cases, it’s not needed. But when the tingling starts when you first start talking to someone … don’t ignore it.
There are a lot of intangibles in medicine, and this is one of them. I can’t explain it, but it’s one of the most important skills I’ve learned, although I have no idea when I did. I’m just glad it’s there.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
