Don't Let Your Brain Fool You

I hope you have ambitious dreams and strive for excellence every day. I want you to learn to trust your gut. You know, when you get that feeling that your gut is screaming at you, but you ignore it in favor of logic or reason or some other factor, like somebody looking over your shoulder, making you second-guess what you're trying to accomplish.

I get those feelings, too, but this is a clear recipe for disaster.

Your gut or intuition is a powerful tool that can guide you towards success. It's like your inner GPS.

It's a way of pointing you in the right direction.

I want to share a story with you to illustrate my point.

I was a newly minted attending working at an ER Trauma Center when I saw this young patient, about 22 or so, who had a nasty sore throat.

It's not super common to get patients in the trauma center on a busy Sunday with a sore throat that can usually be handled by their urgent care, fast track, or any of the handful of quick med centers around the urban trauma center where I work.

But anyway, this kid was there with his parents, and he was in a lot of pain.

I did the usual exam and labs. He had strep throat, which is no big deal. It's pretty easy to treat. I gave him some antibiotics, steroids, fluids, and pain medicine, and he was feeling better.

But my gut was telling me there was something more that I was missing.

Why would the 22-year-old kid who looked to be an athlete come to the ER for sore throat on a gorgeous fall day?

I did a little bit more checking, more questioning of the patient and the family, and considered ordering a CT of his neck, thinking maybe he's got some type of abscess or other weird process going on that I'm missing.

But I had someone looking over my shoulder, and that somebody was the emergency department chief.

I worked at several EDs at that time, and the two chiefs at the hospitals where I was working were both pursuing an MBA. They implemented all sorts of crazy metrics and monitored things, tracking every test we ordered and every scan we performed. I think they competed to become the most annoying colleagues.

As I was preparing to submit the order for this patient's CT scan, the chief said, "That seems like a waste to me. It's excessive. We're tracking this, you know?"

So, I didn't order the scan and prepared to discharge the patient home.

They wanted to get out of there and had been there for several hours already.

About three days later, I returned on shift and found a note in my mailbox, "Hey, remember that kid?"

As an emergency physician, you never want to hear that. Remember that kid? Remember that patient?

If I would have ordered that scan, I would have diagnosed something quite rare.

It's called Lemierre syndrome. An aggressive throat infection can spread into the jugular veins and the chest, creating an infectious mess.

This kid ended up in the hospital for several weeks on IV antibiotics and blood thinners. Fortunately, he did not need surgery, but this can happen in Lemierre's cases.

I did everything initially right with my treatment right up to the point I ignored my gut and canceled the CT. The CT scan results would have triggered me to admit him.

I want to share this case to help you not only trust your gut but also look out for weird things that can and will show up during your time in the emergency department as a physician, PA, or nurse practitioner.

And I've created a course just for that.

I also want to share a few steps to help you trust your gut more.

What we do in the emergency department is based on incomplete information, and that's just part of the job. Still, your gut plays a massive role in this, particularly as you get more seasoned and have that nagging feeling.

I want you to pay attention to your feelings and notice the physical sensations in your body when you're making decisions.

Are you feeling calm and centered, or anxious or unsettled? Do you feel like you're missing something? Often, that's a cue to either order more tests, take a little bit of time, find somebody more seasoned to run it by, or, a lot of times, the nurses there are amazing.

There've been many of them there for decades, and they've seen many things and will help steer you away from the cliff.

I've often had seasoned nurses say, "Hey, what about this?" or "It's best to try this or consider this."

You can also practice mindfulness or meditation. I don't want to get all woo-woo on you, but this can help you learn to tune into your intuition and find calm. Self-care goes a long way towards career longevity.

There's not a lot of calm in the emergency department, particularly a level one trauma center, but just taking a moment to breathe, pause, take a lap, whatever you need to do to really tune into your intuition and trust your instincts.

If the gut feeling doesn't logically make sense, you might need to trust it.

Your intuition knows things that your conscious mind does not. And don't be afraid to make mistakes.

I'm not talking about medical errors, but I'm talking about maybe you ordered a test that you could have skipped.

Maybe you ordered a lab test that wasn't 100% necessary, but these are all opportunities for growth and learning, and you will discover things that you would have missed otherwise.

I tell my kids, "You can't tell how well your car is running by just looking at it." You actually have to lift the hood and look underneath it, and that's just part of trusting intuition, trusting your gut, sometimes sticking your neck out on the line, and resisting that nagging medical director leaning over your shoulder, trying to complete his MBA project. I hope this story was helpful to you.

If you're interested in the course, which is packed full of information, there's a link below this video.

The course is fast-paced. Tons of students have gone through it already, and are implementing their new knowlege.