The Gut...and The Head

We’ve been hearing a lot about the pathways and interactions that connect the skin, the GI tract, and the microbiome. (If you haven’t done so already, check out the October edition online at PracticalDermatology.com.) It’s very fascinating science, coming from a bacteriology major, and there is plenty more to be learned, especially as integrative approaches to dermatology gain more attention.

One of the better approaches to medicine, and probably all parts of life, is to trust your gut so it doesn’t mess with another important system: our overactive brain. In this age of endless propaganda and “intelligence,” where influencers and experts are hatched hourly and devices have replaced conversations and real thinking, trusting one’s gut instincts and being confident—without arrogance—still has its benefits. No one has yet to figure out a good approach to the syndrome called the “know-it-all patient.” But as the new norm has become physicians playing defense against the scrutiny of the Google-trained patient, it is our challenge to balance being confident in our training and approach while still conveying the compassion that a real patient deserves...despite their instinct to review us rather than actually listen.

Usually the genesis of these editorials, just another way of passing the day, is a lesson learned or an observation mixed with either some humility or adult beverages. But this time I write during my family trip to Italy where I spent the first two days kicking myself over losing in my fantasy football championship game in the league with my friends from Milwaukee. Since 2004, I have never won the trophy and it escapes me like a white whale! This year, once again instead of listening to my gut instincts I was immersed in analysis and started some shiny new players from waivers rather than trusting the players with the hot hands who got me there. And even worse, I only have my brain to blame while my gut turns over in angst of another opportunity squandered. Stupid, but you know the drill. But the really sad part was that I heard that my opponent’s mother passed away a day before the match—if that doesn’t put reality into place I don’t know what does. In any case, the point is the brain should have paid more attention to the gut.

What’s more important is thinking about how often that brain paralysis happens in medicine now that there is too much distraction from external, uneducated influences. In the example of my game where I had to set the lineup before the overseas flight and land in Italy to see my score, I was swayed by last minute information that sounded convincing, but was, in the end, wrong. Is that scenario becoming more common for patients who get biased by searches and media reports right before they see us in the office? And the last thing they remember is what makes them grind deeper in resistance against our advice? It tells me that their gut instincts, which drove them to come to the doctor, could be blinded. And of course one’s health doesn’t even compare to fantasy football. But in this example maybe it’s the element of trust that is truly under the microscope, especially in this age where opinions masquerade as facts.

So as much as I despise the teasing I get from my friends about not having my name on the trophy, I despise more the idea of letting myself get swayed by bad information. Trusting one’s gut can be hard, but it is still better than leaving doubt on the playing field—or the clinic.

In any case, I’ll take the family trip and happy patients anytime over the fantasy trophy, and I’ll work on my microbiome in the meantime. Happy 2020!