At some point in the last year, you may have seen posters for “Mind Over Medicine”, a live, interactive medical problem-solving simulation held right here, on the NYUAD campus. If you took one look at all the healthcare artwork and subconsciously dismissed it because you assumed it was only for people on the pre-med track, then this article is for you. Even if you did not, take me up on a bet: I reckon there is a solid chance you would completely miss a real heart attack happening before your very eyes.

Let me make the terms of our wager clear. By “heart attack”, I mean a myocardial infarction*, i.e., the death of a part of the muscular portion of the heart due to a prolonged lack of oxygen. By “miss”, I mean being completely unable to label what is happening as “heart attack” or only doing so hours later.

What do you imagine a heart attack looks like?

If Hollywood has properly done its job, you should be coolly conjuring up an image of a sweaty, breathless, overweight, middle-aged gentleman clutching at his heart and saying something similar to“It’s like an elephant is sitting on my chest!”

Well done. All of that is medically sound, but before you declare victory, consider that 1 in 5 heart attacks go entirely undetected; 1 in 3 heart attacks show no chest pain, with symptoms varying all the way from neck pain to light-headedness, demonstrably delaying care for hours; and people notoriously misjudge vague symptoms.

Still confident you could quickly spot a heart attack amidst all the noise?

In truth, this is not really about heart attacks. It is representative of a broader problem: people run a dangerous, informal, unregulated, often subconscious clinic in their heads long before they ever see a clinician. Assuming we have complete access to trustworthy healthcare, we make at least four critical medical judgements about our daily experiences and sensations:

Is this even medical? Is this normal, or abnormal? Is it urgent, or can it wait? Do I need to see a doctor, or can I handle it myself?

A quick Google of “I ignored my symptoms” is enough to show anyone how misinformed this self-triage can be. Expert bias would dictate that what seems obviously abnormal or dangerous to a physician (or vice versa) is not necessarily obvious to a layperson.

People are more likely to ignore and delay care for symptoms they cannot attribute to a concrete cause. For instance, when a patient tells a doctor that their “shoe and ring sizes keep increasing”, which may indicate a condition called acromegaly, it comes after years of slowly ruling out all easily explainable hypotheses first such as, “I’ve just gained weight”, “My shoes are worn out”, “I’m just getting older". On the other end of the spectrum, people can get overly suspicious of truly minor, harmless sensations that may reach the point of psychiatric illnesses.

It all has to do, at least in part, with how calibrated your internal smoke detector, your self-triage system, is. It has to be good at both alerting you to a possible fire (medicalese: sensitivity) and ignoring harmless noise (medicalese: specificity). Too insensitive, and you will miss real illnesses. Too vague, and you will constantly get alerted to ones that do not exist.

One way to increase your sensitivity is to learn more about illness and the human body. Knowledge alone does not cut it, though.Knowledge requires context, a hint of specificity, or else we would all be rushing to the ER for every minor cold, cut, or headache. For lay people, though, specificity does not matter as much. The cost of you potentially missing a real illness is far higher than the cost of having an unnecessary check-up. It is why you will never see a health resource say “Don’t go to a doctor if”. After all, specificity is what doctors are meticulously trained to do.

That being said, there is another action you can take that increases sensitivity: learning clinical reasoning. I will give you a real-life example of what I mean by this.

It is my first year of med school. We are asked to awkwardly huddle around a seemingly normal, jolly, middle-aged man. Refusing to idle while we wait for an actual doctor to show up, and armed with the highly technical knowledge that nerves were not, in fact, neon yellow, I tried to ‘diagnose’ this gentleman simply by looking at him. Were it not for all the flies, there may have been nothing to see. However, every time one of them alighted on his toes, soles, or the tops of his feet, he did not react. It was only when they settled on his ankles that he shook them off. Aha! I could conclude that:

There is symmetrical sensory loss all around both feet up to what appears to be an imaginary band around the ankle. Sensory loss implies an issue somewhere along this pathway: skin receptors > multiple nerves supplying the foot > spinal cord > brain. The symmetry suggests either a systemic issue or a focal one with symmetrical effects. I know that extremities like the feet are particularly vulnerable to systemic issues, since they lie the farthest from vital organs.

Knowing only one possible cause of this at the time, I ended up posing it to the resident. I was right. He had poorly-controlled diabetes. Of course, this entire chain of thinking was over-simplified. The point is not to try to diagnose yourself or strangers (please never do that), but that if we look at things a certain way, and apply the biological principles that we do know, we can beef up the sensitivity of our initial self-triage. I did not necessarily know ‘what’ to think, but I had had a taste of ‘how’ to think with what little knowledge I had, and that made me notice something I would have otherwise missed.

When done right, clinical reasoning almost resembles magic, and my love for it only grew throughout the years as I read the larger-than-life tales of legendary diagnosticians, rapidly took notes as a professor debated himself on whether a patient had one of four different syndromes I had never heard of before (try saying “hemophagocytic lymphohistiocytosis” 5 times fast), and honed my ability to ridicule medical dramas for dragging out an episode with brazen crime instead of ordering routine tests (think of the series House).

Unfortunately, and perhaps horrifyingly, very little time is allocated to formally teaching clinical reasoning in med schools. It is something you are mostly expected to absorb over time, which is both unsettling and a total shame, because it is a ridiculously fun way of learning medicine.

It is also something that everyone, not just medical students, can benefit from. It teaches you to be intentional and informed when you self-triage, it allows you to see theoretical concepts in action, and it bridges the doctor-patient gap, giving you insight into what information doctors may want from their patients or what format they might want it in. In a world where profit-driven healthcare systems effectively cap visits at 15 minutes, it is something we need more of. It is learnable, engaging, and could potentially help people seek care earlier and advocate for themselves…so we turned it into an event.

We, a team of your fellow undergrads, a space medicine PhD, and a physician-in-training, started Mind Over Medicine to give anyone the opportunity to try their hand at clinical reasoning and learn some practical, take-home medicine along the way. Last year, we held a pilot simulation of a mystery heart disease on campus, complete with food, a patient actor, and a senior medical student. We heard lots of brilliant, useful feedback that we have been working hard on implementing, and we are going to announce our next session soon.

If you are considering going into healthcare and would like to take a peek into how doctors think, or want to learn how to better advocate for yourself or your loved ones’ health, or just love the idea of an intricate mystery-solving session with friends, we would be thrilled to have you stop by. We have a strict “Just Bring Your Brain” policy, so do not worry if you do not know much about biology or medicine. That is the point!