The sixth sense (or how all nurses are a little bit psychic)

In the world of nursing there is a long accepted "nurses intuition" or sixth sense, which means that even when all the evidence points to the contrary we can often look at a patient and say:

"Now ... I don't like the look of him."

Not in the sense that we think are patients are ugly you understand, but in that once you've seen a fair few sick people everyday for a few years, you start to get a feel for when someone's taking, or about to take, a turn for the worse. They could have perfectly health observations but something about that patient tells you to do an ECG or bleep a doctor or at the least keep a closer eye on them for a while.

Which is great, psychic nurses - excellent!

This becomes a difficulty however, when you realize that a patient looking "a bit iffy" isn't exactly quantifiable, we live with a medical system, and I work within one, which relies on things being quantifiable and score-able. In the NHS we have the EWS or Early Warning Score system, which gives you a score for the patients observations, which ideally is 0 - anything above a three and a doctor must be informed.

If you are curious - an EWS chart!

Which is great, it's a fairly fail safe way of monitoring a patients overall health and spotting a problem quickly. However, it really doesn't account for the sixth sense, in which many nurses, doctors and other health care professionals can look at an outwardly healthy patient and know that there is something up. If you can't justify investigations then the general consensus is that you shouldn't be doing them, which is fair enough - you don't replace your car's battery just for fun, or re-tile your roof just for the sheer hell of it. So why would you do an ultra-sound on a patient with no signs of cardiac problems?

But I worry, surely we're ignoring a vital skill that health care professionals pick up subconsciously, a vital skill bred from long experience and acres of knowledge. We're in danger of forgetting that that patient is a human being, with a very complex body that can do all sorts of crazy stuff to confuse us, and see them as a car - which doesn't need to go to the garage until that red light starts flashing. Tools and charts and scoring systems are good, when used in conjunction with common sense and humanity. But rely on them solely and you will a) loose the heart of the NHS and b) miss out on excellent medics who know something is wrong - but can't do anything about it.