My medical decisions are sometimes influenced by what I call the headline factor, where I briefly consider what the newspaper headlines could read should a worst-case scenario play out.
A patient presents with a fever and productive cough, and the history and physical put a community-acquired pneumonia as the most likely diagnosis, but tuberculosis is also on the differential. The patient needs to go to the ER for a workup. He came by bus, and that's how he prefers to go to the hospital. Calling an ambulance for transport seems like overkill. But I can see the headline: "Tuberculosis patient sent by family doctor to hospital by public transit; dozens exposed."
Or the homicidal patient I had a few weeks ago. He came to see me because he felt he could kill someone at the slightest provocation, and this alarmed him. He was eager to walk the few blocks to VGH with an accompanying letter from me for the ER physician and psychiatrist. I considered the headline: "Mother and child stabbed by homicidal patient sent by family doctor on foot to local emergency room."
It's only the cautious side of me that runs through these scenarios. I never daydream about accolades for obscure diseases diagnosed or illnesses cured. But that's not front-page news anyway.