, 2025-04-22 11:19:00
A general practitioner (GP) recently reported that, by chance, he came across a life-threatening diagnosis. He had been chatting with a patient, during which the patient casually mentioned his favorite TV show, “Let’s Dance,” a popular dance competition show in Germany. The patient said that he usually used the commercial breaks to dance with his wife. However, he had recently been struggling to keep up due to his condition. The GP became alert and referred him for an outpatient coronary angiography, which revealed multivessel coronary artery disease requiring bypass surgery.
What would have happened if the doctor hadn’t listened closely? And how do doctors in everyday practice ensure they don’t miss important clues? Read here about the situations that make your colleagues sit up and take notice, and how they manage to recognize almost unnoticed emergencies as such.
How to Recognize a Serious Situation?
We wanted to know from doctors on Coliquio, a Medscape Network platform, if they’ve ever experienced medical emergencies that came up by chance or almost unnoticed. In the discussion, they shared what made them listen closely at the right moment and which three qualities help avoid overlooking important details.
- Reading Between the Lines
Sometimes, it’s casual remarks that make doctors’ alarm bells ring. A Coliquio member from internal medicine shared a case of an older couple who had always come together for routine checkups. When the husband arrived alone one day, the doctor asked why. The answer — his wife had black stools and couldn’t get out of bed — prompted the doctor to immediately call for an ambulance. Rightly so, as the wife was diagnosed with an upper gastrointestinal bleed.
A similar situation occurred with a member from occupational health, who tried to contact a patient about an abnormal stool test. The wife answered the phone and casually mentioned, “It’s difficult right now. He won’t wake up properly and looks kind of blue.” The member immediately called an ambulance, and the patient was intubated and taken to the intensive care unit (ICU). The cause: A severe COVID-19 infection. The original reason for the call turned out to be harmless — the later colonoscopy was unremarkable — but the call itself was likely lifesaving.
- Considering the Patient’s History
The discussion about almost unnoticed emergencies also revealed that many doctors are familiar with patients who avoid taking sick leave even with painful injuries or illnesses, only seeking help “when things get really bad” — as a member from internal medicine put it. When this type of patient requests sick leave for the first time, it can already be an indication of a serious illness.
“A patient I’ve known for years would NEVER ask for a sick note. Whether her ankle was swollen and bruised or she had a feverish infection, she always insisted on working. One day, she introduced herself, saying she had such a headache that she couldn’t work that day. I thought: Brain hemorrhage. The radiologist called me back and asked if I could check the head. A small surgery for drainage later, everything went well,” commented a member from general medicine.
A similar experience happened with another member’s previously healthy 60-year-old patient. At the end of his visit, while saying goodbye, the patient casually mentioned that he sometimes felt upper abdominal pain during his morning walk to the train station. The GP became alert, took the necessary steps, and “less than 24 hours later, the patient had four bypasses.”
Such cases can also occur in personal settings, as a member from general medicine shared. After returning home from the office, she learned that her husband’s friend had to cancel their meeting because he had been experiencing shortness of breath, making it difficult for him to climb stairs. The colleague found this unusual, as she knew him as a healthy man in his mid-40s, and asked if he had had any surgery recently.
Indeed, he had undergone knee surgery a few weeks ago. They called the friend, and the colleague advised him to go to the hospital to rule out a pulmonary embolism. The friend was skeptical but went to the hospital and was immediately admitted to the ICU with an extensive bilateral pulmonary embolism.
- Trusting Your Gut and Insisting if Necessary
Listening to your gut and standing by your instincts are crucial for doctors, even early in their careers. A member working as an on-call intern in the clinic admitted a patient with dizziness, pressure in the head, and epigastric discomfort. “He looked strange — his thorax was livid with slightly distended veins, his legs pale and thin.” The attending physician didn’t take the symptoms seriously.
“I brought in my supervisor because the patient didn’t sit right with me. My supervisor looked at him, asked how much he drank a day, and after his answer (“Well, one beer, maybe”), he looked at me knowingly and smiled. Despite this, I insisted on further diagnostics.”
The intern’s intuition proved right: a CT scan revealed an aortic dissection type A, and the patient had to be urgently transferred to a heart center. Days later, a colleague from the heart center called to thank the intern for the swift action, reporting that the emergency surgery went well.
Right Call, Right Time
In one case, a Coliquio member in radiology noticed a “stiffness” in the neck of a patient referred for a cervical spine CT. The orthopedist who had referred the patient was unreachable, so the radiologist decided to also perform a cranial CT scan, which revealed a cerebellar hemangioblastoma. The orthopedist later complained about the decision, calling it “improper,” but the radiologist stood by the action. “That was my only transgression in 40 years of practice.”
Doctors must make decisions based on their best judgment, even when colleagues may not share their concerns. Trusting your gut and taking necessary steps to rule out serious conditions can be lifesaving for patients.
This story was translated from Coliquio using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
