Medical Maxims, Pearls and Principles: Do You Think Your Doctor is Using Any of These? If You were a Doctor, Would You?
Because there are so many "unknowns" in the diagnosis and treatment of patients,as examplified by the above graphic of a unusual animal hybrid, there has developed a whole host of guides to medical practice that have been handed down over the many years and have been said to provide some help to your doctor in making a diagnosis or treatment. Many of these maxims, pearls and “principles” have never been subject to evidence-based testing but since some appear logical and seem to be helpful, well, they continue to be used.
I selected the following list of 30 of these classic guides from the list that was brought together in the Art of Medicine section of the hand held device program “Clinical Medical Consult” 2009. My answer to the question in the title of this thread is that, yes, I think a lot of doctors have used at least some. Me too. But, in this age of hopefully evidence-based medicine, I wish that all were scientifically proven to be worthy of their current application!
Look through the list. You may want to comment on the logic, illogic, silly, practical,prejudicial, rational, irrational statements and also those you think should be never more handed down from one generation of doctors to the next generation. Also, if you don’t understand the significance of one of these maxims, pearls or principles, just ask me. ..Maurice.
1. Drug reactions can be unique to a single person.
2. There are 3 ways to answer a question: “I don’t know/I don’t know but I’ll guess/I know".
3. Never say “never” and never say “always”.
4. “Occam’s razor” indicates that among competing hypotheses, favor the simplest one. However, “Saint’s Triad” reminds us of the importance of considering multiple separate diseases of a patient when the result of the history and physical are atypical for any one condition.
5. Common things occur commonly… when you hear hoofbeats think of horses not zebras.
6. Place your bets on uncommon manifestations of common conditions rather than common manifestations of uncommon conditions.
7. If what you are doing is working, keep on doing it. If what you are doing is not working, stop doing it.
8. If you don’t know what to do, don’t do anything.
9. Treat the patient and not the X-ray.
10. Never let the sun set on a pleural effusion.
11. Think twice, cut once.
12. All that wheezes is not asthma.
13. Never give two diagnoses when you can find one that explains everything. (Moderators note: but also consider #4.)
14. If it is dry, wet it: if it is wet, dry it.
15. Sutton’s law: “go where the money is”: do the most obvious test or biopsy first.
16. The only bowel sound that matters is a “fart”.
17. The child that does not resist invasive or noxious procedures is sick.
18. All bleeding eventually stops.
19. All drugs work by poisoning some aspect of normal physiology.
20. Don’t order a test unless you know what you will do with the results.
21. The less indicated a test is, the higher the rate of false positives.
22. Lower abdominal pain and a lower abdominal tattoo equals pelvic inflammatory disease (a sexually transmitted illness)
23. Never worry alone, get a consultation.
24. The delivery of good medical care is to do as much nothing as possible…the more we intervene the more problems we might cause.
25. “Better” is the enemy of “Good”.
26. Never be the first to adopt the new, nor the last to give up the old.
27. When the test result and the patient’s exam contradict each other, always “believe” the patient.
28. The chances of a patient is pregnant is inversely proportional to the degree that she insists pregnancy is not a possibility.
29. “Poop” is all colors of the rainbow—don’t worry unless it is black or bloody.
30. Children will put anything anywhere, think foreign body.
Graphic: Widely distributed photograph of a Zorse, horse-zebra hybrid as an example of potential complexities and confusions possible as doctors try to diagnose and treat human illness.