Pause, pattern, plan 

By John Decarlo, MA, MDiv, AB, Hofstra University 

 

This guide is designed to spark thoughtful reflection on delivering exceptional care to every patient. It turns the gut feelings we have in complex situations into simple, patient‑centered prompts. It doesn’t replace evidence—it helps us pause, think broadly, and choose the next best step for the person in front of us. When something feels off, match that feeling to one of the patterns below and use the prompts to refocus on the patient’s needs, values, and safety. 

 

Eight patterns to translate instincts into action: 

 

1. Positive analogy: a familiar picture with a small twist

Feeling: “This looks familiar, but it needs a tweak.” 

Try this: Keep the core plan and refine the details. Ask, “What small adjustment would make care safer, kinder, or more effective for this patient?” 

 

2. Oppositional analogy: the findings don’t fit 

Feeling: “This conflicts with what I expected.” 

Try this: Consider the opposite of your default. Ask, “If I changed the timing, the test, or the approach, would it better serve this patient’s goals and reduce risk?” 

 

3. Synthesis: combining strengths 

Feeling: “I’m torn between two good options.” 

Try this: Blend approaches to capture the best of each. Ask, “How can we integrate perspectives so this patient has the best plan possible?” 

 

4. Thin place: small clues matter 

Feeling: “Something subtle here could change everything.” 

Try this: Slow down and look closer. Ask, “What small detail—history, imaging, labs, symptoms—might help us tailor care more precisely to this patient?” 

 

5. Blind spots: a gap remains 

Feeling: “We’re still missing something important.” 

Try this: Expand the frame. Ask, “Are we overlooking the patient’s environment, supports, or comorbidities—and how could addressing them improve outcomes and experience?” 

 

6. Inversion: reframe from first principles 

Feeling: “Maybe our core assumption is off.” 

Try this: Step back and rethink the story. Ask, “If we start with the patient’s values and daily life, would a different model of care be more effective?” 

 

7. Pluralism or holism: many moving parts 

Feeling: “This is complex; several things matter.” 

Try this: Plan for interactions and trade‑offs. Ask, “Which combination of medical, psychosocial, and practical supports will help this patient thrive?” 

 

8. Wild or divergent: outside the usual boxes 

Feeling: “This doesn’t fit the standard patterns.” 

Try this: Stay open and cautious. Ask, “How can we explore thoughtfully, keep the patient informed, and validate each step before we commit?” 

 

Putting it into practice: 

1. Name your feeling and match it to a pattern. 

2. Generate one to three focused next steps that improve clarity, safety, and comfort. 

3. Check these steps with the patient’s goals and values, evidence, and team input. 

4. Document the rationale and set a time to reassess with the patient. 

 

Guardrails to keep us mission‑focused: 

1. Use instincts to guide but not to replace data. 

2. Seek disconfirming evidence to avoid bias. 

3. Revisit the plan as new information and patient preferences evolve. 

4. Keep the conversation with the patient at the center so every decision reflects what matters most to them. 

 

Every patient deserves exceptional care. This guide may help us listen to our instincts, slow down, and choose care that is precise, compassionate, and aligned with each patient’s values. 

 

 

Click here to read more about the author.

 

 

 

 

 

 

 

 

 

 

 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.