What’s the Worst Thing It Could Be?

To kick off our Telluride experience, today we watched Helen Haskell recount the tragic story of her son’s death at the hands of the healthcare system in From Tears to Transparency: the Story of Lewis Blackman. While watching the film, Dr. Tim McDonald offered a great pearl of wisdom about arriving at a diagnosis. He said to always ask “what’s the worst thing it could be?” when piecing together a clinical puzzle in order to avoid premature closure and confirmation bias. As a rising second-year medical student, this advice resonates with me and I will carry this story and this advice with me as an example of how things can go awry when we lose sight of the importance of keeping an open mind and looking at all of the clinical clues.

I think Dr. McDonald’s advice rings just as true is in the realm of team dynamics as it does in physical diagnosis. All too often, patients are harmed in hospitals at the hands of well-intentioned providers. More often than not, when an event like this happens, a member of the care team had an inclination that something was wrong or unsettling but did not feel like they had the authority to speak up on the patient’s behalf. As a medical student, I have felt at times as though my job is to observe and absorb without offering input. The story of Lewis Blackman reminded me of how dangerous this attitude can be– silence and reticence to “bother” an authority figure ended up costing an innocent young man his life.

To keep things in perspective as I progress in my career, I’ll re-frame Dr. McDonald’s advice as it applies to team dynamics in the clinical setting: if I see something that concerns me, what’s the worst thing that could happen? If I raise the issue with a superior, could they find me incompetent or annoying? Maybe. If I don’t raise the issue, could another human being pay the ultimate price because I was more concerned with self-preservation than the safety of my patient? Maybe.

Through this lens, the choice is easy. No one ever died from looking stupid.