Rule No. 3: Let your premonition, intuition, and even superstition make you a better physician.

My own belief is that the best medicine is practiced from the gut and not from the brain. Frequently I see medical students or residents get a hunch about what might be wrong with the patient. But instead of going with their sixth sense, they’ve learned to squelch their instinctual impulse. Hours or days later - sometimes far too late - they discover their initial hunch had been correct. I believe we need to teach doctors to tune, sharpen, and harness these instincts. Play your hunch if there’s nothing else to help guide your therapy.

Often we get a “gestalt,” an overall inkling from a patient, that whatever is going on is worse than it might initially appear. Are you going to put that patient in the intensive care unit to be closely observed? Or are you going to shrug off that impression and discharge the patient home because there are too few “facts” to keep him or her in the hospital? What would I do? I’d put the patient in the ICU. Why? Because nine times out of ten my intuition will prove correct. Of course, that can make folks believe you’re a great doctor because you anticipated what happened to your patient. You’ll know it was your intuition. But it may be true you were a better physician because you had the guts to play your hunch.

Occasionally, as physicians, we will get a visceral tug that something really bad is about to happen to one of our patients. A sense of fear comes over you as the treating doctor. A cold tingle travels over and down the scalp. The hairs on the back of your neck stand up. If they could, those little hairs would be screaming out: “Watch out! Danger!” I’ve had those feelings many times and have always been glad, in retrospect, that I heeded their warning. More than a handful of my patients are alive because of those little hairs. I’d ask you this: who do you think will be the better doc? The one who listens to his or her intuition or the one who doesn’t? So when the little hairs on the back of your neck stand up and start talking to you…listen!

Superstitions are a different matter. I don’t know why certain baseball players stop shaving or changing their socks when they’re on a winning streak. Some superstitions only make sense to the individual who honors them and seem idiotic to those who don’t. In Africa, I began to understand superstition in a new and different way. I saw superstitions as ways that nature might suggest certain paths or behaviors to prevent or forestall misfortune.

I’ll admit that if I spill salt on the table, I throw some over my back. I’m not fond of black cats. I believe lying about a family member being sick might bring illness to them. I believe you can jinx things by getting too cocky about them. I believe that if you go into the operating room and announce that this case will “be a piece of cake” then nature pays you back for your hubris. If a patient asks me to rub his lucky rabbit’s foot before the case starts, I’m there, rubbing away.

Many superstitions have a basis in some tangential or poorly understood connection. For example, there’s an old wives’ tale that dates back to the Middle Ages. It cautions mothers: “Beware the child whose brow tastes of salt.” Now that seems an odd admonition. But consider children who are born with disease cystic fibrosis (CF). Up until recently, CF was a relatively rare but lethal illness that claimed children in their infancy. The genes that cause cystic fibrosis also make a baby’s sweat glands excrete excessive amounts of salt—hence the salty brow. But it was once dismissed as silly superstition!

In Africa, I visited a village that was in the midst of celebrating five girls in the tribe who had come of age because of the onset of menarche. When I arrived, I was informed that I would have to stay and wait until the three-day long rites were completed. I was told that any attempt to supply medical care or administer drugs during the ritual celebration could be quite susceptible to being turned into evil by sorcery and witchcraft. Evil spirits, the villagers told me, hovered about the village at this special time when a woman was especially susceptible to the influence of evil magic. Okay, that might seem like a silly superstition.

The set up was that the five young women were secluded for three days in a hut especially erected for this ceremony. This hut was constructed entirely by the hands of women. No man was permitted to touch any part of it during its assembly. All males, even infants, were forbidden to set foot inside the hut. If a man disobeyed these rules, then, it was said, the women’s magic would then destroy him.

Inside the special hut, the women elders of the village attended to the girls. I was told that during the three days, the older women would pass on their magical rites related to fertility, making men fall in love, having only boy children, and so on. At the end of the three days, the young women came out of the hut, adorned with wreaths of green leaves. They walked in a procession in front of all the eyes in the village, displaying their proud, new status as women.

I was content to have three days rest and to take in the colorful and obviously important rituals celebrated by the village. My companion for this trip was a rather cocky, young nurse technician. He had been raised in the capital city of Libreville and considered himself quite the cultivated and educated young man. He sat next to me, shaking his head in disbelief at the silly superstitions of these “backward natives.”

After the ceremony was over, he started to become quite ill. He developed a scorching fever, shaking all over with chills, and perspiring profusely. I put an intravenous in his arm and started administering antibiotics on the presumption that he had become septic from some bacterial infection. With each passing day, he continued to worsen. He was so ill that I dared not attempt to transport him back to our hospital compound, which was more than two days travel from the village. On the fourth day, he was close to dying, and I was dumbfounded because I didn’t have a clue what was killing him. He confessed to me that on the second night he had slipped out and just to prove a point had touched the outside wall of the hut and then had sneaked his foot under the edge to prove that he could set foot in there with impunity. Well, he confessed he had been wrong about that. Dead wrong, I’m afraid. We buried him outside the village. When I returned to the hospital compound and was asked to fill out the cause of death on his death certificate, I wrote down “infection,” But I really believe the cause of his death was from violating a taboo. Superstition or not, it killed him all the same.