Blink

I've been reading Malcolm Gladwell's books since Darren received them for Christmas, and I'm not quite sure what to take from them yet. Blink discusses how humans have developed the ability to make very good decisions at a glance, but how these decisions can be horribly wrong if we don't have the correct background of information. A great story that leads off the book is about a good number of art historians who knew that a piece was a forgery, but couldn't quite put their finger on why. The other book of his that I read was The Tipping Point, which discussed how some events, such as disease epidemics and fashion trends, begin because of a few specially connected people. I am currently in the middle of his latest book, Outliers. I mention these because Blink has really gotten me thinking, and I wonder if I can apply any of the lessons of the book to my daily interactions with patients. While running today, I realized I already have on several occasions.
As an intern in orthopaedics, most of my struggles came while trying to build up my background of information. Orthopaedists read their own x-rays (while ignoring radiologists), but this is a skill that took me several months of practice to pick up. The advantage we have over radiologists (and why we ignore them) is because we have physical exam findings to correlate with the radiographs. For instance, I often pick up subtle findings on xray that radiologists don't simply because I know that the patient hurts at a certain location. By the same token, I have had to see patients with no injury because a radiologist thought they saw something that simply wasn't there.
Another example of knowing something without knowing why happened to me a few months ago at work. My intern called me about 2am about an inebriated young woman who had been struck by a car and was complaining of severe leg pain. Xrays were negative for fracture and the patient constantly screamed how she was going to sue the driver. She was also screaming in pain at the most minor of movements to her leg (these are all strong predictors for not really having an injury). When I examined her, her leg muscles were all soft (this essentially rules out compartment syndrome), there were no gross deformities, and her nerve function seemed to be intact. She was also not cooperating with any exam, so I couldn't do as much as I would have liked. It was also 2am, and I was cranky having to deal with a histrionic, drunk, annoying patient. But something was wrong, and I could not figure out what. I remember calling my attending and telling her that my spidey sense was tingling (really, I used those words). As the patient's pain continued unabated the next day, we did an MRI just to prove that she was crazy. And of course, she wasn't. She had an Achilles tendon rupture, which I completely missed due to such a limited exam (and xrays can't pick that up). Now in truth, Achilles ruptures generally don't hurt that much (it's like a really, really bad sprain), but at least something in me knew her exam didn't make sense. She had surgery to repair it a few days later.
So have my skills increased over the past four years? Undoubtedly. Do I still make mistakes? All the time, but now I have the background of experience and education to make a whole lot less.