The One Attitude That Saves You Time And Energy On The Long Run

As I was finishing up writing the previous patient’s note, the lab technician brought me the CBC results of my next patient, Ms. V. Ms. V is a premenopausal woman who sees me for iron deficiency anemia. Her hemoglobin that day was less than 7 g/dL, which was not surprising to me. She was known to have heavy menstrual flow and she had not returned to see me for more than 6 months. When I saw the platelet count was low, in the 60,000 range, my initial thought was focusing on what could be wrong with the patient. Almost simultaneously, I was questioning the integrity of the specimen.

I walked down the hall to our lab. As a hematologist and oncologist, having a CBC machine is practically a must in my opinion. Maybe I am spoiled by my training that included knowing the blood count results in minutes after the blood was drawn. While I was taking those twenty or so steps, I was curious, questioning the possible causes of the patient’s low platelet count. In previous visits, regardless of how anemic she was, her platelet counts were always normal or slightly higher than the upper limit of normal. I brought this up to our technician. Without hesitation, she checked that specimen – sure enough, in that EDTA tube, there was clot formation when there was not supposed to be. The next appropriate action was to ask my medical assistant to redraw Ms. V’s blood. The  repeat blood test revealed the hemoglobin again in the sub-7 range, and the platelet count was over 450,000, slightly higher than the normal range.

There are many steps involved in getting a CBC result of a patient, which means that error may occur at any step of the way. This is true in many situations. When there are multiple steps involved to do a task, something may go wrong at any step. It is our duty to question the results if they are not as expected.

The best attitude to have is to be curious. Curiosity opens our mind to be willing to explore different possibilities, even to entertain ideas we have not thought of.  When you are curious, it allows you to examine the situation more objectively. Yes, trust the process but not blindly believing in everything you see. If something does not seem right, question if there could be an error somewhere along the process. When you are curious, there is less judgment. You are focusing on getting the correct outcome (that does not mean you will always get the desired outcome).

Repeating the test or the task may seem time-consuming. Going back to Ms. V’s example. I requested the medical assistant to repeat the blood draw. This also meant I had to wait for another few minutes, after the second blood draw, to get the new results. Those extra steps in fact saved a lot of time and brain power. Had I believed in the initial platelet result, I would be starting the evaluation for it.

Being curious opens your mind to ask more questions. This is especially helpful in the patient encounter. The patient may not be telling you the whole story, either they are not comfortable or they are not sure what is pertinent to let you know. By questioning the patient’s answers and the way they answer, you will ask questions which are helpful to find out more details or the ultimate truth about the situation. With this, you can approach the patient with a plan that is best tailored.

Being curious will minimize the use of short-cuts or the skip of certain steps. I am not saying that you should avoid any type of short cuts. You want to obtain the patient information the right way. For example, a nurse may relay a message to you about a patient. When you call the patient back, be curious if the message you received was accurate. This will minimize misunderstanding. It will help you get to the core of the patient’s concerns.

Being curious is quite fun. There is sometimes that mysterious feeling. It is as if you are looking for treasures, or you are an explorer in an uncharted territory. When you are curious, your mind opens. You are less judgmental. You get to minimize mistakes and get to understand what the patient wants and needs quicker. This means that you are providing better care for your patients.