Shortcuts to intuition:
Situations which should prompt doctor to by wary:
1. Seeing a patient twice in one day (or in a short space of time). It could be patient driven or doctor driven. ! Why has the patient needed a second review? !Is there something else going on?
2. Anger in a patient which appears to be disproportionate to clinical picture. ! Could it mean there is something more serious happening?
3. Discuss your mistakes with a colleague and/or GPR. ! There may be lessons in them.
4. Clinical signs not matching in a sick patient. ! When a pattern does not fit, the case may require a rethink.
5. Listen to parents in particular. ! They will know when their child is behaving differently than usual and when they are different from other times they have been sick. Parental anxiety in a usually relaxed parent.
6. Be aware of your own emotions and try to prevent them adversely affecting your clinical judgement, for example a patient arriving in without an appointment could be as risk of not being fully assessed.
7. Consultations where a patient presents with a friend or relative particularly when this is unexpected e.g. ! both parents attending with a child (where usually just one attends). ! Two friends attending together. i.e. Any “joint consultation”.
8. Infrequent attenders presenting with symptoms which you feel they would not usually attend with. Similarly, patients who are out of character e.g. an infrequent attender presenting with a headache.
9. Patient coming from another practice.
10. Patients who appear slow to leave when you feel the consultation is over – do they have another agenda?
11. When something doesn’t fit – is there another explanation or is it an atypical picture?
12. Patients who decline investigations or admission – could there be an underlying reason e.g. hidden drinking.
13. Watch out for red flags: e.g. ! Weight loss. ! Night pain. ! Past history of cancer.