Intended for healthcare professionals

Student Education

Intuition and the ill infant

BMJ 2001; 322 doi: https://doi.org/10.1136/sbmj.010498 (Published 01 April 2001) Cite this as: BMJ 2001;322:010498
  1. Denis Gill, professor of paediatrics1
  1. 1Children's Hospital, Dublin, Ireland

Nowhere in medicine is the use of observation, instinct, and innate experience more important than in attempting to make a clinical diagnosis in an acutely ill infant. I like to refer to this as veterinary paediatrics, as sick animals and sick children share many attributes they refuse to eat; they lie down when they are sick; their language and communication skills are limited; they depend on others to sort out their problems; and when ill they prefer to be left alone.

Sir William Osler said, There is no more difficult art to acquire than the art of observation. This is well captured in the illustration of the sick child, a painting which used to hang on the wall of many doctors' surgeries (fig 1). It shows the doctor carefully observing an ill child placed across the chairs in a poor household. His posture is pensive, his look inquiring, but the child's position and that of the parents tell the viewer that the child is critically ill.

Figure 1

Sir Luke Fildes “The doctor” shows the doctor carefully observing an ill child

I like to quote to my students the saying of Auguste Bier (1861-1949): “A smart mother makes often a better diagnosis than a poor doctor.” In reality, of course, any mother is likely to make a better diagnosis than a “poor” doctor. About 70 to 80% of paediatric diagnoses are basedlargely on history. It is essential that students ask the mother what her worries are. Figure 2 displays the fundamental problem the child or young infant being limited in his or her clinical vocabulary and yet needing to communicate to the mother or the attending doctor. Fortunately, most mothers are excellent barometers of their children's wellbeing and are good communicators of their problems if doctors are attuned to listen. …

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