Uncommon Sense

Some doctors say intuition can help to diagnose patients—but others are skeptical

- Amitha Kalaichandran

JONATHAN SHERBINO was nearing the end of his solo, nine-hour shift one December evening in 2011 at an emergency room in Hamilton, Ontario. He’d spent much of the day peering at ear canals, taking throat swabs, and ordering X-rays in quick succession with few breaks. As the only doctor present, he knew he couldn’t linger for too long on any one diagnosis.

A three-year-old with ruddy cheeks was next in line, her nose running profusely and mixing with the warm tears streaming down her face. When Sherbino examined her, she seemed to have all the telltale signs. Fever: check. Cough and runny nose: check. Contact with someone who had the flu: check. Nothing appeared unusual in her medical history. It was likely she had the flu.

But as Sherbino, an emergency physician at St. Joseph’s Healthcare Hamilton, prepared to sign a prescription pad for an antiviral medication, something forced him to slam the brakes. “It was as though I couldn’t keep writing,” he later told me. “My mind was stopping me . . . it was like a cognitive block. Something just didn’t fit the clinical picture.” He returned to the mother to ask her a few more questions. The child’s fever, it turned out, was on its fourth day, which was somewhat odd — for most children, in his experience, a flu-related fever lasts two or three days. Her lips were also peeling — a symptom not usually associated with the flu.

“It could very possibly be Kawasaki disease,” Sherbino recalled thinking at the time, referring to a childhood disease of unknown cause. Its symptoms often include at least five days of fever, red eyes, swollen lymph nodes, and a rash, along with other signs that appear later. It is also rare: in many Western countries, the disease occurs in one in every 10,000 children under the age of five.