When I was doing my EMS training, one of the career EMT/Firefighters talked to me about a call we had just run one night. It was an older woman with abdominal pain. We get those kind of calls all the time. He asked me “so, what did you think of that call?” I told him that she seemed kind of routine to me and there could have been a variety of different causes for her abdominal pain. “Right,” he replied, “and quickly, you will develop a sense for when those seemingly routine calls are not routine by just looking at the patient and seeing that something just doesn’t look right.”
That kind of judgment that comes with experience obviously can’t be taught, but perhaps the “nose for trouble” that comes with practice alone is not enough to be good at what you do. Atul Gawande, in his book Better, A Surgeon’s Notes on Performance , talks about the importance of vigilance, borne out of a desire for betterment. In the introduction of his book, he tells a story about an old woman who “didn’t feel good,” much like the EMS patient I had. He recounts that this woman came into the ER at the hospital when he was in his residency, and he thought she was probably fighting an infection, and that’s about all the thought he gave to her. The senior resident, however, was not so sanguine. He thought she “didn’t look right,” and so he went back to check on her twice between rounds. As a result, he caught the fact that she did, in fact, have pneumonia and the infection had progressed to sepsis (an infection in the bloodstream), which can rapidly be fatal. As a direct result of his diligence, he spotted her sepsis fast enough to avoid having to put her on a ventilator and she was released in a few days.
Gawande attributes the senior resident’s instincts and more importantly, his vigilance, as critical in changing this woman’s outcome. “What does it take to be good at something in which failure is so easy, so effortless,” he wonders. He concludes that one of the essential ingredients to be good is diligence — that this makes a doctor better. Competence is not enough.
His lessons are equally applicable to almost any discipline. The legal profession would be well-served by this sort of self-reflection. One place where I think it matters greatly is in parenting. And no where is the necessary diligence as challenging than in parenting the child who can not tell you what is wrong or what is bothering him or her. Parents of infants and those special children with whom the world can never communicate must read subtle signs and be ever vigilant.
So, on this Mother’s Day, my hats off to those of you who pursue whatever it is you do with a sense of diligence, whether it is being a great teacher, mother, caregiver to an ill family member, a nurse, a doctor, or EMT. You truly are better for it.
