One of the most important things you learn to do as a doctor is how to manage risk. A patient, any patient, comes to your attention because they need you at that moment;  you assess them as they are during that snapshot of time. You take notice of your patient’s appearance, the way they walk into your room, the way they speak. You’re watching their intakes of breath, how they hold your eyes or how they look away. You pay careful attention to what is in front of you. It’s not just about the questions you ask, or the answers you hear. You’re making a global assessment of how your patient is doing, and all these tiny pieces of information inform your decision-making.
But it doesn’t stop there. You scan what’s come before; the trend of blood results or your patient’s blood pressure, or their temperature earlier that day. You read their notes to find out what was happening last week, and you look ahead too. After all, if the numbers just about fall into the normal range, but have been ramping up for weeks, then they could be in a bad way soon, and you have an opportunity to catch it now and do something.
What are the possible trajectories for your patient in the resuscitation bay, while you go to find another colleague to assist you? Could those crucial seconds or minutes have an impact? What could happen in the weeks or months between clinic appointments, and how can you bridge the time in-between to ensure that things don’t deteriorate?
It’s a game of looking backwards and forwards and straight ahead - a very difficult skill to develop. You feel that skill build, over the months, over the years. You start to look at charts differently; not just what’s there right now, but the imaginary lines pulling off the chart in different directions. Sometimes it’s clear, and sometimes it’s hazier because you don’t always have a chart to fall back on. Sometimes you just have your gut instincts. You hear a patient reassuring you that they’re feeling better now, not suicidal, not the same as yesterday. But they avert their eyes as they say the words, or twist their hands. It gives you pause.
I learned over the years that if you pause and are uncertain, then that’s an alarm bell. You must force yourself to stop, pay more attention, speak to trusted colleagues, and make your next decision really carefully. Sometimes, of course, all of this is an over-reaction. You keep a patient in hospital longer to observe them, and it was unnecessary, they were fine. But on other occasions, those pauses save a patient’s life. I think about this a lot at the moment, because this skill doesn’t stop with medicine. When you meet someone socially, you’re subconsciously scanning them for signals. You pick up on things that others don’t. You’re always scanning, and the reason you’re scanning is that doctors aren’t perfect. We stay alert to minimise the times when we could miss something important. Doctors turn their decisions this way and that, considering them from other angles and relying on others doing that too, scrutinising us to ensure that we don’t miss things.
When we turn on the news or listen to the political podcasts talking about the election right now, we’re not hearing many journalists do this. They’re not picking up that swirling glass of public opinion and tilting it this way and that, watching what happens when the light hits it differently. We’re not seeing journalists examine the state of UK politics and the fast-approaching election from different angles, wondering about the promises of these parties and the likelihood that they’ll follow through on those promises. We’re not watching them spin that glass too fast, until droplets fly off, and watching where they fall. Sitting the glass down and watching where the sediment settles.