Acting on instinct: blessing and curse #WILTW

This is the 123rd #WILTW

In the last 100m of the final race of the World Triathlon series  Alastair Brownlee gave up his own position to help his brother Jonny complete the race 

Alastair acted on instinct. He doesn’t look around to see if anyone is catching him, he doesn’t pause and think, he just supports his brother and walks him across the line.  The reaction of some was to declare Alastair’s actions outwith the spirit of sport, ‘competitors shouldn’t help each other‘, but what would the reaction have been if Alastair had carried on to leave his brother to collapse to the floor?

Alastair said it was a natural human reaction to help his brother (although he did add he “… wished the flipping’ idiot had paced it right and crossed the finish line first..” )

Even with a number of different options available to you, acting on instinct is relatively easy if the outcomes of your actions can be easily ranked. Alastair’s love for his brother outweighing his desire to win the race.


What if your instinct to do something is challenged because undertaking it may have adverse consequences. This may seem like a ridiculous scenario but it is not uncommon in busy Emergency Departments, or other areas, managing unwell and sometimes critically unwell patients. As we approach winter in the United Kingdom we will be faced with increasing volumes of children, generally with respiratory disease, who become ill extremely quickly. At any given time you could be managing a baby, a  toddler and a teenager all with signs and symptoms requiring experienced input and intensive treatments.

…and then another patient can arrive looking blue, fatigued and close to collapse. The instinct to run to them and help impossible to ignore. And receive care this patient must – primum non nocere.  But doctors and nurses in charge of clinical areas have additional responsibilities. Not all resources can be directed at one patient. The most appropriate staff, with the most appropriate skills, must be re-directed to the most appropriate patients. Continually robbing Peter to pay Paul as more and more patients arrive over the course of an evening steadily increases cognitive load and stress on those running the department.

Whiteboards in ED

If the newly arrived patient is unwell, but not critically so, this creates the greatest instinct versus ‘other action’ challenge. There are no correct answers to maintaining the right balance between being appropriately involved a few patients care and ensuring situational awareness for all patients.  Time spent evaluating extent of illness and redeploying resources appropriately takes senior staff away from managing and treating patients directly.  Healthcare systems appreciate and plan for this; overall leadership of a department one of the core skills of an Emergency Department Consultant.

I wish though, like Alastair Brownlee, acting on instinct had no real consequence, but I am also very glad that this instinct exists and I hope it always will.

What did you learn this week? #WILTW

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