In this Boston Globe health piece, Dr. Suzanne Koven writes about intuition, what she describes as “The feeling of knowing something you don’t have an apparent reason to know.”
In this case, she wrote about the emotional and physical response she had to a patient who felt unwell, a certainty she had that he had Lyme disease. Lyme disease is a particularly complex example of medical intuition, given the lack of truly definitive testing, and in that way, it highlights just how crucial those moments of intuition are. Koven makes it clear medical intuition is more than simply a feeling; it is “a logical, if abbreviated, reasoning process.”
As a patient, I know firsthand how life-changing medical intuition can be. Ten years ago, my then-rheumatologist was sitting in her office, chatting with another patient, when she suddenly had a thought. She called me and said she thought I might have celiac disease, an autoimmune disease wherein the body cannot tolerate gluten, a protein found in wheat and other grains.
I didn’t have any classic gastrointestinal symptoms, but celiac doesn’t always present classically. I did have unexplained joint pain and fatigue, inflammation, a relative who’d been diagnosed with celiac disease, which has a genetic component, and a practitioner who was willing to act on a reasonable hunch (or perhaps an abbreviated, logical exercise in reasoning) and then see what the science yielded.
“I can’t explain how it just came to me, but I have a feeling you have celiac,” she told me over the phone, urging me to come in and begin the testing. Ultimately, her instinct was correct, and when the tests revealed celiac and I eliminated gluten from my diet, the results were immediate and unequivocal.
As many patients can attest to, intuition works both ways. How many times have we been told test results show nothing is amiss when we know there is? How many hunches have we followed, even when professionals have discouraged us from doing so? That little voice, that intuition that tells us to keep searching, not to be swayed by test results that just might be measuring the wrong things altogether, can be a powerful asset.
For patients with chronic or otherwise hard to diagnose conditions, this balance between what medicine and technology can give us and what our bodies tell us is particularly powerful.
The same year I was diagnosed with celiac, my life changed even more dramatically. After years of being misdiagnosed as severely asthmatic, I sought out an airway specialist and finally received the diagnosis of primary ciliary dyskinesia (PCD), a rare genetic disease. My former doctors kept telling me I should be getting better or I must be doing something wrong, but my body told me a different story. I knew something else was going on, and I unwilling to remain in this cycle of hospitalizations and medical crises any longer.
When biopsies and tests confirmed my diagnosis, I had a medical label that matched my actual experiences. I had more effective treatments and access to preventive strategies, and my physical health improved dramatically. Emotionally, I had something else, too: relief from the doubts that had plagued me for years.
Following medical intuition doesn’t mean eschewing science in favor of emotions or hunches, and it doesn’t mean ignoring facts as they appear or refusing to accept conclusive results, either. Rather, I see it as being willing to take a diagnostic leap when necessary, even if that sometimes means waiting to see if the science catches up with us, or points us in a different direction altogether.