Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Superstition

I don’t consider myself an especially superstitious person. I don’t buy into the idea of the supernatural or "grand schemes." I generally believe we make our own futures, while our current actions affect the future through logical chains of events, rather than karma equalizing our lives.

Every once in a while, though, I find myself acting on superstitions. This past week was a case in point. On Thursday, I assisted one of my partners with a bimalleolar ankle fracture that became quite challenging. We managed to complete the surgery successfully, but it was definitely harder work than anticipated. The following day, I had two of my own cases scheduled at the same hospital. On that morning, as I was pulling into the parking lot, I noticed the same open parking stall in which I had parked the day before. Despite the closer parking position, I avoided this spot and parked further down the aisle. I admit it: the rational doctor that just admitted to his lack of a superstitious nature purposely parked in a different stall because he didn’t want to "jinx" his upcoming surgeries.

Tonight's Premier Lecture is
21st Century Triage: How to use Risk Stratification to Improve Outcomes
by Jeffrey M. Robbins, DPM

What is it about superstitions that have even the scientifically & oriented, rational, non-superstitious among us acting on those very superstitions we supposedly don’t believe in?

Clearly it’s not just me that acts on these irrational superstitions. Medicine is full of them. In fact, superstitions are so prevalent that they warrant actual medical research.

The black cloud bad luck reputation may build on itself, leading those residents

For example, certain doctors are thought to carry "black clouds" — everything bad that can happen will happen when this doctor is around. The emergencies will be more significant, the volume higher, the patients more difficult to handle while such-and-such doctor is on duty. This superstition is so prevalent that Tanz and Charrow studied this phenomenon for almost a year using first year pediatrics residents ². Those residents labeled as "black clouds" were no more likely than their peers to have worse outcomes or more difficulty during their shifts. However, the negative reputation was perceived to exist by both the "black cloud" residents and their peers! In this situation, the perception may build on itself, leading those residents to have a decrease in performance, i.e. a sort of self-fulfilling prophecy.

The full moon did NOT have any effect on patient volume, ambulance runs, or admissions

Similarly, ER physicians may be heard saying, "There’s a full moon out tonight" when the emergency room is especially busy or has an unusual number of difficult patients. In 1996, Thompson and Adams¹ performed a retrospective analysis of 150,999 ED visits during a 4 year period to see if there was any accuracy to this statement. As you might expect, the full moon did not have any effect on patient volume, ambulance runs, or admissions.

ER personnel have similar superstitions, such as bad luck Friday nights, or God forbid, Friday the 13th. Take notice that it is "quiet" in the ED, and you’re guaranteed to receive not only sharp stares but also sharp tongues.

In 2004, medical interns and residents of varying specialties were given a survey to examine the prevalence of superstitious beliefs¹. Incredibly, they found the following beliefs:

22% of residents said they were superstitious in general
65% said certain residents worked under a black cloud
48% tried not to say the word "quiet"
40% believed rain made call easier
12% believed rain made call harder
20% felt the moon’s cycle affected their call
10% believed in lucky scrubs or talismans
7% believed in "call gods"

What benefit these superstitions have for us is up to debate. Whether it’s a holdover from a pre-scientific time, provides us a sense of control over a constantly changing medical environment, or if it’s just complete nonsense, we’ll likely never know. Until we figure this one out, I’ll just have to continue to wonder, "Do red-headed patients really bleed more?" Maybe it depends on the full moon or what clouds are in the sky….

What routines or behaviors do you do to keep the "gods of bad luck" away from you and your patients?...

Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

###

References:

Naidech A, Parekh N, Kahn M. Superstitions of house officers. Resident & Staff Physician, 2004; 50(3):47-49.
Thompson D and Adams S. The Full Moon and Patient Volumes: Unearthing a Myth. American Journal of Emergency Medicine, Mar 1996; 14(2): 161-164.
Tanz R and Char row J. Black clouds. Work load, sleep, and resident reputation. American Journal of Diseases of Children, May 1993; 147(5): 579-584.