“Fear is beneficial. It happens for a reason. Everything we have in our heads is evolutionarily beneficial for the most part. The benefit of fear is it allows you to predict the evil sh*t that's going to happen and avoid it.”

This is another episode from Rob Orman's Stimulus Podcast. Rob is my best buddy and the best interviewer in the business. In this episode, we discuss:

The distinction between carrying fear and being afraid

Good doctors carry fear with them. Those who don’t carry a healthy dose of respect for the risks of their actions can be dangerous.

Fear should be your friend. It should be one of many internal voices that you listen to and to which you decide whether you want to regard or ignore.

Fear should not be your limiter. “If fear is your primary internal theme, then you're afraid. And that's a problem.”

The importance of embracing the idea that sick patients don’t take a joke

The sicker the patient, the less room you have for error. Be very careful.

The Five Fears

1. Scott’s fear number one: lawyers

This is a healthy fear as long as you use it the right way. Shared decision-making and good documentation help to keep this fear positive.

It’s a bad fear if it prompts you to practice defensive medicine and do things that patients don’t need or want (such as order unnecessary tests or procedures).

When you document, be sure to show that you thought of the life-threatening diagnosis and why you did not think it was the cause of the patient’s complaint.

2. A common fear that Scott does not personally experience: being an imposter 

This is the inner voice that says negative things about your performance and capability of getting the job done.

Scott’s mindset has always been to assume that his baseline skill level at anything is zero until there is external calibration. With this cognitive assumption, he has never had an inner voice speaking negatively to him.

In emergency medicine there are plenty of opportunities to externally calibrate your skill set (eg. following up on patients to see if your diagnosis was correct or keeping a log of your first-pass intubation success rate).

3. Fear of Monday morning quarterbacking 

This is a useful fear to have because it allows you to foreshadow what you're going to experience tomorrow and the chance to fix the situation today.

While Monday morning quarterbacking can yield strategies for improvement when done in a positive fashion, it can also be done badly and be an opportunity to serve insults.

“The fear of Monday morning quarterbacking should drive your documentation more than it drives your practice.” And if you can anticipate what the Monday morning quarterback is going to harp upon, it should drive you to take actions to have the appearance of due diligence.

4. Fear of procedural complications

Procedural complications can be prevented by breaking them down into distinct micro skills that can be individually mastered.

No matter how adroit one is at procedures, having a certain level of fear of the potential complications is healthy. That fear makes you question whether the procedure is truly necessary, or whether it would be safer done in another setting such as the OR.