Loshini Rajentharan
Liverpool, United Kingdom

When I was a house officer in a tertiary hospital in northern Malaysia during my four-month orthopedic rotation, I witnessed something that changed the way I viewed a particular aspect of medicine.

Superstitions.

I have always loved the color black. Even now, I own enough black clothing to go days without repeating an outfit. Back then, as a house officer, I wore black more often than not simply because I liked it.

One weekend, during an orthopedic rotation in northern Malaysia, the surgeon on call suddenly stopped and stared at another house officer. The offense was not a misplaced test result or incomplete exam.

It was a shirt with yellow stripes.

The surgeon told him to go home and change before rejoining rounds, muttering about how thoughtless clothing choices could ruin an entire on-call shift. He looked me up and down, taking in my entirely black outfit. “That’s much better,” he said approvingly. “Everyone who joins my rounds when I’m on call should be in full black.” He wore black scrubs himself most of the time.

Another medical officer casually mentioned that he never wore red underwear on call. The reason, he explained, was simple. Red attracted a bloody on call. Local surgical doctors in Sarawak, in East Malaysia had even studied this belief, testing whether wearing red clothing correlated with an influx of emergency trauma cases.¹

I stood there fascinated. Here were highly trained professionals discussing colors and underwear with the seriousness usually reserved for antibiotic choices or fracture management. At the time, I found it amusing, though I may have internalized some part of it. Black remains my preferred color for on-call shifts. If black is not available, I gravitate towards calmer colors such as dark green. I remain strangely reluctant to wear anything red, even to the socks I wear.

That was the medical culture I grew up in. It was also where I first encountered the concept of a “Jonah.”

For those unfamiliar with the term, a Jonah is similar to what some colleagues in the United Kingdom call a “black cloud” doctor. Everything goes wrong when they are on call—the referrals begin early, emergencies keep coming, patients deteriorate, admissions pile up. Researchers have actually put this notion to the test and found that the “black cloud” exists entirely in selective memory, but not in the data.² Some believe Jonahs are simply unlucky. Others insist the busiest shifts somehow find the doctors most capable of carrying them. Regional studies in neighboring Singapore documented clinicians’ superstitions and behaviors to ward off the dreaded “Jonah” curse, such as relying on pre-shift rituals and avoiding taboo foods.³

Whether one views it as superstition or gallows humor, every department seems to know who its Jonahs are.

Years later, when I moved to the United Kingdom to continue my psychiatric training, I expected many things to be different. The superstitions, I assumed, would be among them. I was reminded of these one night as I handed over my on-call shift to my overnight colleague. In what I genuinely intended as a kind gesture, I said:

“I hope you have a quiet call,” I offered kindly. There was a brief silence, followed by an awkward chuckle.

“Well,” he replied carefully, “I’d rather not comment on the quietness of the call.”

I immediately realized what I had done. I had said the Q-word. I apologized reflexively, realizing that the details of our medical superstitions and rituals may change with geography and culture, but the instinct to abide by them does not. There is data on this one, too: the word “quiet” has zero statistical impact on emergency workloads. Yet the taboo remains untouched.⁴

Another example emerged through a phrase I rarely encountered growing up: Touch wood.

Although my family spoke English at home and English remains the language in which I think, many of the patients I treated in Malaysia did not speak English fluently. As a result, “touch wood” was a phrase I knew but rarely heard in clinical settings.

In the United Kingdom, a report that things are going well, whether from patients, clinicians, or caregivers, will almost inevitably be followed by the words “touch wood,” often accompanied by the action itself.

Lately, I have noticed something slightly embarrassing. Whenever someone says it, I catch myself instinctively looking for a nearby piece of wood. Sometimes this happens even during telephone reviews. The person on the other end of the line cannot possibly see me. Yet my hand still wanders towards the nearest wooden surface.

There is also the full moon, another belief that appears remarkably resilient despite geography. During my years in psychiatry, I have lost count of the number of times colleagues have commented that things become busier during a full moon. Back in Malaysia, a colleague from another specialty once asked me whether psychiatric presentations genuinely increased during certain lunar phases.

At the time, I laughed the idea off. These days, I am less certain. Not because I believe the moon causes mental illness, but years of clinical work have taught me that medicine is filled with stories, patterns, coincidences, and observations that people carry long after evidence has spoken. It is an old habit of our specialty. After all, the Latin luna gave us the word “lunacy” centuries before modern datasets repeatedly proved that lunar phases have no actual bearing on psychiatric admissions.⁵

All of this leaves me wondering about something. What we do is not evidence-based medicine. At least, not this part of it.

Medicine is a profession built on scientific inquiry, clinical trials, guidelines, and data. Lives depend on our commitment to evidence. Yet many of us still avoid particular colors, refuse to say certain words, touch wood when discussing stable patients, and eye the full moon with suspicion. I sometimes even wear one sock inside out, a habit left over from a story I read as a child in which doing so was said to bring good luck before difficult days.

Medicine confronts us daily with uncertainty. We know more than any generation of doctors before us, yet we still cannot predict every deterioration, prevent every complication, or guarantee every outcome. Knowledge grants us influence, but does not grant us control. The anthropologist Bronisław Malinowski noted that magical rituals always flourish precisely in that gap, the space between what we know and what we can control.⁶ We use them not when outcomes are certain, but when a domain is subject to hazards beyond our intervention.⁵

Perhaps these rituals survive because they offer a way of living with uncertainty. Not because we truly believe black clothing changes the course of an on-call shift, or that uttering the word “quiet” genuinely summons chaos, but because medicine constantly reminds us that there remains a space between what we know and what we can control.

For all our algorithms, protocols, and guidelines, we remain human beings caring for other human beings. Perhaps touching wood, avoiding the Q-word, and wearing black on call are small reminders of that humanity.

Or perhaps that is simply what I tell myself when I realize I am once again dressed in black, with one sock more likely than not turned inside out.

End notes

1. Lim Kim Ying and Chea Chan Hooi, “Does Red Clothes Lead to a ‘Hot’ Surgical Call?” Scientific poster/presentation, Sarawak Regional Clinical Research and Surgical Proceedings.
2. Sharon Brooks et al., “Does the Myth of the ‘Black Cloud’ Doctor Hold Up to Scrutiny? An Analysis of On-Call Workloads,” Postgraduate Medical Journal 94, no. 1110 (2018): 210–214.
3. Erle C. H. Lim et al., “Take a Bao if You Are Not Superstitious,” Annals of the Academy of Medicine, Singapore 36, no. 3 (2007): 217–218.
4. Charles R. Brookfield et al., “The ‘Q-Word’ Superstition in Emergency Medicine: A Randomized Controlled Trial,” Emergency Medicine Journal 36, no. 12 (2019): 748–751.
5. Charles L. Raison, Heather M. Klein, and Modele Steen, “The Moon and Madness Reconsidered: Lunar Cycles and Psychiatric Admissions,” Journal of Affective Disorders 53, no. 1 (1999): 99–106; Russell G. Foster and Till Roenneberg, “Human Responses to the Geophysical Daily, Lunar and Seasonal Cycles,” Current Biology 18, no. 17 (2008): R784–R794.
6. Bronisław Malinowski, Magic, Science and Religion and Other Essays (Boston: Beacon Press, 1948).