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 ====
Nov - 15
Dec - 19
Jan - 21
Feb - 8
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More on premature closure and mystery novels
16 Oct2009
Our favorite whistle-blower points out that sooner or later one must end the diagnostic journey. I tried to make this point: make a tentative diagnosis and then determine if the data fit that diagnosis. My point is that we should pay attention to the natural history of disease and the patient’s course over time. Often we make logical diagnoses on day 1 but must rethink the diagnosis on day 3.
My main point is that we should be ready to re-open our diagnostic consideration when given new clues. I call this the Columbo phenomenon. When the data do not fit the diagnosis, restart your thinking engine.
But whistle-blower’s point is well taken. I know about 20 causes of hypercalcemia, but I do not test for all of them in every patient. Often when you hear hoof-beats it is a horse. The key is that we must attend to the clues that there is no horse and a zebra is on the loose.
I still see major mistakes made when we ignore major clues that the high probability diagnosis is not the patient’s diagnosis. How we balance premature closure with inability to close represents one component of the art of medicine.
Related posts:
- Mystery novels and diagnosis
- Avoid premature closure
- Lisa Sanders writes about Sherlock Holmes
- Our challenge – the long tail
- 15 days at the VA – day 10
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- In: Medical Rants