The Black Swan: Have You Missed One? – PAs Connect

Source: PAs Connect

It’s been said that wisdom is the combination of knowledge and time. As  PA students, I think we have a duty to pick up on little nuggets of wisdom and store them away. While visiting with an obstetrics patient who was being evaluated for pre-eclampsia, I harvested a nugget of wisdom from my preceptor I feel is worth sharing.

The discussion between the obstetrician, James Leonhardt, MD, and the patient was like two different conversations taking place at the same time. Dr. Leonhardt was attempting to convince the patient that her hypertension might be indicative of pre-eclampsia and that she required in-hospital observation. The patient rebutted by trying to minimize her possibly life-threatening condition.

Dr. Leonhardt’s line that finally convinced the patient that she should be admitted for a short blood pressure observation was, “These things are like black swans. Just because you haven’t seen one in a while, doesn’t mean they aren’t out there.” With the last word I whipped out my notepad and scribbled it down.

After the patient headed off for OB observation (and everything turned out fine), Dr. Leonhardt and I had a nice chat about the value of “hoping for the best, preparing for the worst.” He reminded me that the severe, life-threatening conditions that are drilled into our heads during school and training are certainly the zebras and black swans we will rarely see. That said, there is still no excuse for missing those sporadic events that threaten our patients’ lives.

That evening I reflected on my family medicine clinical where a vast majority of patients faced addiction and mental health conditions. It was incredibly common for the patients to try and talk themselves out of dealing with a potentially dangerous situation—much like the patient with hypertension.

As healthcare providers we might be tempted to dismiss a patient’s comment or skip a part of the physical exam because we don’t think it will yield anything. This inclination exists in all of us and, if fate allows, could strike at the exact moment the proverbial black swan tries scooting across your pond. The discipline and professionalism needed to recognize such thoughts and push through with an excellent standard of care are what defines our profession.

The reality of medicine is that tough diagnoses exist and need to be made. Some days, we will be tired, hungry or angry, but we must remain vigilant. And before we know it, we will be the mentor, and through our words and deeds we will pass on these tidbits of wisdom acquired while learning the art of medicine.

John (JJ) W. Jenkins is a second-year PA student at Carroll University in Waukesha, Wis. He is an Army veteran and past president of the Carroll University PA Student Society (CU PASS).


The Black Swan: Have You Missed One? – PAs Connect