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The Unknown Unknowns

Medicine is all about constantly asking questions. Why is it so? Can it be done better? What am I missing? What’s the diagnosis? What labs/tests should I order? What kind of treatment(s) can I offer?

Anesthesiologists analyze pools of data and make quick, confident decisions minute-to-minute. We question why the patient is hypotensive, tachycardic, coagulopathic, oliguric, febrile, etc. and tailor our differentials and treatments accordingly.

As a senior resident, I have to trust the junior trainees (both student nurse anesthetists and residents) to take care of their respective patients and ask for help when they encounter difficult situations. Early in the academic year, they simply don’t have a sufficient case load under their proverbial belts to know how these surgeries can take a turn for the worse.

But how about situations we don’t even recognize as potential problems? We don’t know the answer, AND we fail to ask the question. These unknown unknowns are far more difficult to catch among trainees. How can we let them spread their wings and fly solo while simultaneously maintaining patient safety? The prospect of not even recognizing that something is a red flag is worrisome, but I constantly go through the operating rooms and survey every aspect of every case to ensure a glaring mistake was not glossed over.


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