Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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Mystery novels and diagnosis
15 Oct2009
Long time readers know that I love mystery novels. While many literary critics look down at genre fiction, I would argue that the best mystery novels comment on society, the diagnostic process and the human condition.
I have read several mysteries recently that reminded me of the diagnostic challenge. In many mysteries, the protagonist must look past the easy answer and struggle to find the correct answer. I would argue that excellent internists must do this.
The big error in medicine is premature closure. We all make this mistake, the best clinicians less often. We have premature closure when we see an “obvious” diagnosis and proceed with that diagnosis. We err when we start to ignore new data that do not fit the “obvious” diagnosis.
As I stated last week, “Many diagnostic errors occur because we try to fit the data to our hypothesis rather than fitting the hypothesis to our data.”
How do we avoid premature closure? We have a responsibility to the patient to keep our minds open to alternate possibilities. For students and residents, this error and the defense against this error explains why we obsess on differential diagnosis. If we develop a complete differential diagnosis, then we will at least consider all the possibilities. We who teach internal medicine are not being picayune, but rather stretching our concerns and the learners’ concerns so that we do not miss an important diagnosis.
I greatly enjoy reading a mystery novel in which the key is not superior intellect as much as a dogged persistence. The smartest internist is not necessarily the best, unless that internist also remains dogged when the data do not make sense.
Related posts:
- More on premature closure and mystery novels
- a db quote
- Do not marry the diagnosis!
- Our challenge – the long tail
- More on the art of diagnosis
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- In: Medical Rants
1 Response to Mystery novels and diagnosis
Michael Kirsch, M.D.
October 15th, 2009 at 9:10 pm
I agree, but sometimes closure is the right answer. Clinicians who are too expansive or indecisive are handicapped. We will never reach 100% certainty of a diagnosis, and we need to know when to pull the trigger. This threshold changes in every patient, depending upon the disease severity, risk of missing a significant diagnosis, patients’ (or their family’s) demand for more certainty, fear of litigation and physicians’ style of practice. These are issues of medical judgment, which are honed over time. When I see patients with elevated liver enzymes, I don’t look for Wilson’s Disease, even though it’s on ‘the list’. While premature closure is not ideal, delayed closure is equally deleterious. http://www.MDWhistleblower.blogspot.com