Day 1 & Premature Closure

The discussion of the Lewis Blackman film raised many issues, the first of which was the problem of understaffing/different staff on nights and weekends. It struck me that a problem of sheer logistics could have such an impact on someone’s health – how we know illness and disease strike to the beat of their own drum, but yet we try to impose our 9-5 schedule onto them. With so much of medicine still at the whim of chance and unforeseeable risks, why would we continue to allow this dangerous practice that is entirely under our control?

Helen’s comment that she was “the only constant” throughout Lewis’s care gets to the heart of the issue for me- when the sole duty of a health care team is to care for the wellbeing of their patients, how can we accept anything less than constant care?

“Premature closure” was introduced in the discussion and used to describe the practice of making a diagnosis, then subsequently ignoring new data that conflicts with this diagnosis. While the term itself is new to me, the idea was sadly quite familiar. Much of my anxiety about practicing medicine is finding the confidence to make a diagnosis and treatment plan, and believing in yourself enough to follow through with this plan when there is always a chance that you’re wrong. And being wrong means potentially harming a patient. In my Introduction to Clinical Medicine class this past year, we were tasked with learning how to take a patient history and make differential diagnoses. I still remember feeling acutely uncomfortable when they answered our questions about how to structure a writeup with all of the information we get from interviewing the patient. They described the History of Present Illness as a sort of persuasive argument, meant to be delivered to the resident/attending and convince them of the same diagnosis at which you have arrived. While they weren’t telling us to ignore conflicting information outright, the gist of their advice