going with your gut

source

Great article on the all too easy, all too often assumptions we can make as physicians, and the consequences: Afraid to Speak Up to Medical Power (from the NYTimes), based off this NEJM submission

Noteable excerpt (on sending a patient to surgery who clearly wasn’t well):

“We realize that, each of us unsure, we gained confidence from the perceived assurance and expertise of the other. We unearth the other specialists who participated in the patient’s care…The general internist bowed to the others, and the surgeon was approached as the next service provider in line. Tragically, no one person looked beyond the effusion to the whole patient. Although he saw myriad specialists in his last week of life, he died lacking holistic care

Conclusion:

“…In a profession abounding with experts, no one person’s expertise can always count for more. Although certain technical skills may be specialty-specific, there’s a much broader range of skills on which no group has a monopoly. There’s no chain of command in using gut instinct, showing concern for the whole patient, avoiding harm, or curtailing futile care. We must recognize that debate is healthy and that without open communication, we fill the space by guessing at each other’s motives.”

Lesson? Speak up and go with your gut. If all else fails, at least you’ll learn something.

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