To be a good doctor, be a Pathfinder

Reactive medicine is often the worst type of medicine.

If you're not familiar with pathfinders, they're a group of soldiers who are often dropped into the combat zone to provide reconnaissance, and set up drop zones, landing sites, and act as the first eyes and ears of the following soldiers.

Pathfinders map and assess.  They act and signal.  A good doctor is a pathfinder.  If you even spend one day watching someone's vital signs drop to just above shock range, then they go into shock without you doing anything, that's just bad.  For the patient and your career.

If you consult for a problem and the consultant points out that there's something you didn't treat for which originated the consult in the first place, that's just bad.  For the patient and your career.

You don't want to be the guy who didn't treat infection X for days or be the guy who thought "Hmm I'll just watch these blood pressures drop.  They don't have a fever anyway,"  and then your "stable" patient is gone from your care and in the intensive care unit.

I've already seen this a ton and I'm a little unnerved.  Just because someone goes from 140/80 (for example; this isn't a real patient) to 103/65 doesn't mean they're going to remain "stable."

If you see that, what you need to be doing is start running differential diagnoses, culturing if you think it's indicated, getting the right labs, an echo if it's indicated, and so on.  You need to start thinking about the patient's renal and cardiac status as you think about fluid resuscitation and pressors.  Get the bedside cardiac echo.

Medicine is a lot like chess.  You have to think ahead or the patient loses.

Medicine is a lot like war.  You need to know what you're dealing with and find out the best approach.  If you fail, the enemy reinforces (septic shock occurs, arrythmia occurs, preventable code blue is called).

Family docs aren't the only ones who do preventive care.  It should happen all the time, everyday on every service.