It was three in the morning on the acute take. A woman was struggling to breathe, and I thought I knew what was wrong.
The history fitted. The findings of her examination seemed to fit. I had already started thinking about treatment before I’d finished examining her. It felt like knew, no guessing.
Then I did something very ordinary. I wrote out the problem list. Partly for the notes, partly for whoever saw her next. Mostly from habit.
A few lines in, I stopped. I noticed two of the findings were sitting there next to each other on the page, and they didn’t make sense together. In my head, they had been part of one neat story. On paper, they clearly weren’t. I had missed that.
She didn’t have what I was about to treat her for.
I had simply moved the thought from my head to the page. And once it was there, I could see the problem.
That moment has stayed with me.
We tend to think that thinking happens in the head and writing comes afterwards. First you work something out, then you write down the answer.
But often the writing is the thinking.
Your mind is good at making things feel complete. It joins the dots, fills in gaps and quietly drops whatever doesn’t fit. Most of the time this is useful. We couldn’t function if we had to examine every thought from scratch.
When under pressure, that shortcut becomes risky.
When you’re tired, rushed or worried, you don’t usually experience your reasoning as messy. You experience the result of it and it’s easy to feel certain.
You can’t see what your mind left out.
This is one reason I keep coming back to Cognitive Oxygen®, the buffer space needed to think carefully. Pressure reduces that space making our thinking faster, our view becomes narrower. We jump from problem to answer without seeing much of what happened in between.
Putting a thought on paper gives some of that room back.
It has to slow down, once it becomes words, you still need enough time to look at it.
And then you can ask: does this actually make sense?
That’s also the point of Red Team Thinking®. It sounds more complicated than it is. At heart, it means trying to find the weakness in your own idea before the world finds it for you. What have I assumed? What haven’t I checked? What would make this plan fail? What am I not seeing because I want to be finished?
These are hard questions to ask of a thought that still lives entirely inside your head where it can change shape too easily. When in writing on the page, it has fewer places to hide.
I once watched a senior team discuss closing a service and moving its work somewhere else. By the end of the meeting, the decision seemed settled. Everyone was nodding. There was a sense that we had talked it through.
Maybe we were also just tired. Then someone went to the whiteboard and wrote four headings: What do we know? What are we assuming? Who is affected but isn’t in the room? What would show us we’re wrong?
That was it. Nothing clever.
Under “What are we assuming?”, someone wrote that the other service had enough capacity to take on the work. The room went quiet. Nobody had checked.
We had all been treating it as a fact, but only because nobody had said it clearly enough for the rest of us to question it.
It took about nine minutes to understand the plan was not going to work.
The whiteboard let us see what we had actually not been thinking.
You could say this is just note-taking, and sometimes it is. Writing things down doesn’t automatically make them thoughtful and smart. You can fill a page with tidy headings and still avoid the difficult part.
The question is whether the writing changes anything. Did it reveal a gap? Did it make you uncomfortable? Did you notice that something you called a fact was really just an assumption? Did it change what you did next?
If not, you may only have recorded the decision you had already made.
There is something strangely convincing about a thought that feels finished. Sometimes it just means your mind has done a good job of hiding the rough edges from you and it’s not a proof.
At three in the morning the problem list helped me see them.
So this week, try this with one decision you feel sure about. Put it on paper under four headings:
What do I actually know?
What am I assuming?
Who or what is missing?
What would prove me wrong?
Give it nine minutes.
You may end up making exactly the same decision.
But at least you’ll have had a proper look at it first.