Funtabulously Frivolous Friday Five 142

A patient can have as many diseases as they damn well please.

Occam’s razor can be paraphrased

when investigating a patient with multiple symptoms, a single unifying diagnosis should be sought

William of Occam (1287 – 1347)

John Bamber Hickam (1914 – 1970) was a faculty member at Duke University in the 1950s. Hickam’s Dictum was a response when one single unifying diagnosis is not possible.

Hickam was not the first to question William of Ockham as Walter Chatton a theologian and philosopher (c.1290 – 1343) often sparred with William and came up with the “anti-razor“.

Chatton proposed:

Whenever an affirmative proposition is apt to be verified for actually existing things, if two things, howsoever they are present according to arrangement and duration, cannot suffice for the verification of the proposition while another thing is lacking, then one must posit that other thing”.

That is; if Occam’s razor does not satisfactorily determine the truth, another explanation is required.

no set of inconsistent observations can exist that some human intellect cannot conceive a coherent explanation for

Be careful of over-attachment bias to a particular diagnosis.

And finally, Occam’s duct tape:

…avoiding the simple explanations to make multiple unnecessary assumptions

Rene Laennec (1781-1826) revolutionised the examination of the chest with the first stethoscope.

Physicians no longer needed to press their ears against the chests of their patients to auscultate the chest and accurate clincopathophysiological correlation became possible.

The familiar binaural stethoscope, with rubber tubing going to both ears, was not developed until the 1850s. Regarded as the father of chest medicine, Laennec demonstrated the importance of the instrument in diagnosing diseases of the lungs, heart and vascular systems. Ironically, he died of tuberculosis.

Loss of ability to appreciate the weight of objects held in the hand, or to differentiate objects of different weights.

Caused by a lesion of the contralateral parietal lobe.

Emergency Doctors. [Reference]

Before you all jump to Dermatology for a few extra years of life (19 to be precise), the study had many faults but interesting none the less. The searched the obituaries for 7 years in the BMJ from 1997 to 2004, so a fairly limited population while the college for emergency medicine was relatively young in the UK (less junior trainees and females to balance the stats, plus only 17 doctors in that cohort). Interesting facts from the study:

Cardiologists are not immortal

Radiologists die from more neurological pathology…… too much radiation??

Higher rate of deaths from accidents in the emergency cohort. Maybe we should stop living life in the fast line at home.

• Patel K et al. Lifespan and cardiology. Br J Cardiol 2009;16:299–302