Listening to the Little Voice Inside


That nagging little voice can sometimes save you from a medical mistake, so don’t ignore it.

Fam Pract Manag. 2020 Jan-Feb;27(1):38.

Author disclosure: no relevant financial affiliations disclosed.

Pat was a 78-year-old patient who didn’t much like going to doctors. Complaints of no energy, a low-grade temperature, and vague right-lower-quadrant pain brought her to see me. She had been having symptoms for five days but was not in any distress. Overall, she looked pretty good; she took no prescription drugs and had a fairly clean medical history. On exam, she had stable vital signs, no fever, a benign abdomen, and a negative urinalysis. She did mention being told she had diverticula on a colonoscopy years before but had never had a bout of diverticulitis.

Wanting to be thorough, I ran her blood and came up with nothing but a white blood cell count that was at the upper limit of normal. “Let’s see where this goes,” I told her, and made her a follow-up appointment for a week later — sooner if necessary.

When she came back, she said she hadn’t been to work in a week because she hadn’t felt well enough. Something was up. Pat never missed work. I performed another exam, and this time she had right-lower-quadrant tenderness. She was still afebrile but said it came on at night. “Pat,” I said, “this could be diverticulitis or perhaps a walled off appendix that may have perforated. Let’s repeat the blood work at the hospital lab and see what’s up. I’ll call you later today with the results.”

Most of my labs get picked up by a courier and the reports come the next day from a reference lab out of town, but I wanted Pat’s results ASAP.

When I returned to the office after lunch, the test results still weren’t among my faxes, so I called the lab to get them. The lab confirmed that they were ready and agreed to fax them. When they didn’t come through despite several attempts, I finally asked, “Can you just tell them to me over the phone?”

The lab tech had a unique accent, and I had a hard time understanding him. “White blood cell count 12.1, C-reactive protein 2.02,” I thought he said. He did not mention any critical


Dr. Brown is a solo family physician in Mendocino, Calif.

Author disclosure: no relevant financial affiliations disclosed.

Note: The patient’s name has been changed.


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