A sixth sense

Highly commended in our ‘gut feelings’ category, Dr SD on ‘That one patient’ with more than meets the eye…

Late 1990’s. First GP partnership. Not quite the steep learning curve of house jobs, but still challenging.

I had just finished the usual busy Monday morning surgery with a cacophony of extras and was heading for the lunchtime partnership meeting.

‘Doctor, a visit request has just come in,’ interrupted the receptionist. 

Stifling a groan, I collected the notes and dipped back into my room hoping to postpone the visit and make it to the partners’ meeting. Absence was not appreciated; especially for the new boy. My hopes were raised by realising the patient was the grand age of five. Mum was requesting a visit as Alice was unwell with a sore throat. 

‘What’s wrong with Alice?’ I asked when her mother answered my call. 

‘Well she has had a sore throat for two days. Last night she was seen by the out of hours doctor and given antibiotics but is no better’ the mother explained. Trying to hide the irony, I asked how many doses of the antibiotic Alice had taken.

‘Two, and I was about to give the third,’ she replied. She confirmed that Alice was eating and drinking, had no temperature and was not being sick.

‘So, what’s worrying you about Alice?’ I queried. 

‘Well she’s just not right!’ 

‘What is Alice doing now?’ 

‘She is sitting on the sofa watching TV, drinking but looks tired,’ her mother replied.

The mother did sound sensible, unlike some of our patients… I considered my options and offered to see Alice straight away. 

Five minutes later, I was sitting down in the meeting room with a well earned caffeine fix. I was surrounded by the usual mix of interested and disinterested faces, when the receptionist interrupted me for the second time that day. 

‘Doctor, this little girl is not well!’ 

Mum had managed to bring Alice over and had parked outside the entrance, but was struggling to lift the child out. I quickly introduced myself to Mum as I noted the child was unresponsive but breathing. As I stuck my head through the car door, the diagnosis was obvious as I was assailed by the fruity sweet smell of ketones! 

Quietly berating myself for not visiting, I scooped up Alice and ran to the treatment room, whilst asking for someone to call 999 for an ambulance. However, with our nearest acute hospital being a 30 minute drive, I suspected the lassie’s fate was in primary care’s hands now. 

With the help of the practice nurse, venous access was accomplished and a bag of life saving saline started whilst confirming blood sugar of ‘off the scale!’ was noted. The ambulance arrived as I gave the on-call paediatrics team the heads up, whilst trying to reassure mum that Alice would be in good hands. Alice’s mother had revealed a three day history of polydipsia prior to her sore throat. 

Alice recovered in hospital and will be 29 now. I still to this day do not know why I even agreed to see a patient who was no better after two doses of antibiotics with a history from a sensible mother. Maybe it was a sixth sense – or the subconscious memory of my GP trainer being called to a baby who ‘was not feeding well’ to discover a cot death. 

But thankfully I did see them. Delaying that consultation would probably have been fatal and perhaps ended my, then, short career. It’s the reason why, even after 26 years as a GP, I hate telephone triage, especially for children!