Heeding those voices in your head

Issue: BCMJ, vol. 54 , No. 9 , November 2012 , Pages 445 Editorials

Would you like fries with that?” It’s hard to ignore the voice inside my head. I filter about 99% of what it says (which I am sure is surprising to those who know me well), but sometimes things slip out.


Would you like fries with that?” It’s hard to ignore the voice inside my head. I filter about 99% of what it says (which I am sure is surprising to those who know me well), but sometimes things slip out. By the way, just in case you are wondering, the above is not an appropriate response to a patient’s litany of complaints. Neither is, “Why don’t you just shut up?” or, “Would you like some cheese to go with that whine?” 

Sometimes the things I let slip can go over well… with the right patient. For example, “Bob, have you noticed that we have an unequal relationship?”

“What do you mean Doctor?”

“Well, it is always about your needs? It’s always you, you, you. It’s never about me or my needs.”

“Oh, Dr Dave, you make me laugh.”

I’m not suggesting that all of you let your inside voice out (come on, you all know you have one) but perhaps we should give it more credit. The voice that encourages me to go, “Goochy goo” when examining someone’s axillae or “I am going to pump you up” (with Austrian accent) when taking blood pressures is also often the voice of reason. I have learned in over 20 years of practice that this voice is frequently trying to tell me something important apart from, “don’t pass gas in the exam room.”

On more than one occasion I have ignored my inner voice at my patient’s peril. We are often so busy and distracted that we easily miss the symptom or sign that should have triggered our interest. So many pressures pull from all directions that we gloss over some important detail—and then there it comes, “the voice.” “Slow down,” it says. “Pay attention,” it cajoles. “Something isn’t right,” it affirms. If I take the time to register these words and heed their advice I am always thankful. 

My inner voice has helped me make diagnoses of potentially dangerous conditions that I might have otherwise missed. I would like to tell you that I have never made a mistake, but then I would be lying (and on my way to a career in politics). I sometimes try to ignore my inner voice when it wakes me up repeatedly during the night: “Go back, check again,” it niggles. I try to allay my discomfort with platitudes and clichés. I tell myself that it couldn’t be, or that condition is so rare that I must be imagining things. One time, after a nighttime nagging session from my inner voice I fell asleep only to dream that my laboring patient was an unrecognized breech—a fact that was confirmed in the morning with an ultrasound. Oh, that damn voice.

We are taught that voices in our head aren’t really a good thing, but I beg to differ. I would encourage you to get in touch with yours and heed its advice. 
—DRR

David R. Richardson, MD. Heeding those voices in your head. BCMJ, Vol. 54, No. 9, November, 2012, Page(s) 445 - Editorials.



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