Sutton’s law: When making a diagnosis one should first consider the obvious, and initially conduct those tests which could confirm (or rule out) the most likely diagnosis.
1952 – The law is named after Willie Sutton (1901–1980), a bank robber renowned for escaping from prisons. Finally apprehended, Sutton was allegedly asked by a reporter ‘Why do you always rob banks?‘ to which he replied ‘Why, that’s where the money is.‘ [Published: ‘Redlands Daily Facts’ 15 March 1952.]
His logic spurred William Dock (1898–1990) in 1960 to coin ‘Sutton’s Law‘ as it pertains to medicine…to ‘go where the money is’. On rounds as a visiting professor at Yale, Dock met a young Puerto Rican woman with an undiagnosed liver disorder despite an extensive series of tests.
Suspecting the diagnosis of schistosomiasis he said ‘Why don’t you apply Sutton’s Law?‘ i.e. in this particular patient, perform a liver biopsy. The biopsy confirmed ova and the diagnosis.
1961 – Yale physicians Robert Petersdorf and Paul Beeson were on that very teaching round and published a paper examining ‘Fever of Unexplained Origin‘ in which Sutton’s Law was first recounted as a footnote.
We are indebted to Dr. William Dock for the term Sutton’s Law. It recommends proceeding immediately to the diagnostic test most likely to provide a diagnosis, and deplores the tendency to carry out a battery of ‘routine’ examinations in conventional sequence…’
Sutton’s Law gained immediate popularity because it reminded physicians to bypass unnecessary, inconclusive, and often expensive studies.
1976 – Although Dock was the inventor of the eponym ‘Sutton’s law,’ Sutton himself denied ever saying that.
‘The credit belongs to some enterprising reporter who apparently felt a need to fill out his copy,’ wrote Sutton in his autobiography. ‘I can’t even remember where I first read it. It just seemed to appear one day, and then it was everywhere. If anybody had asked me, I’d have probably said it… Like Dr Dock said, it couldn’t be more obvious. Why did I rob banks? Because I enjoyed it. I loved it!’
- Dock’s Law
- Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961 Feb;40:1-30. [PMID 13734791]
- Sutton W, Linn E. Sutton’s Law. In: Where the Money Was: The Memoirs of a Bank Robber. Viking. 1976 p120.
- Milne H. Linear Diagnosis. In: The Heart of Listening: A Visionary Approach to Craniosacral Work. North Atlantic Books. 1996 p97
- Cheng TO. William Dock. Am J Cardiol 1999;84:1215–25.[PMID 10569333]
- Rytand DA. Sutton’s or Dock’s law? N Engl J Med. 1980 Apr 24;302(17):972. [PMID 6987522]
- Altman LK. A Law Named for Willie Sutton Assists Physician. The New York Times. Jan 3 1970
- Cheng TO. William Dock, Willie Sutton and Sutton’s Law. Int J Cardiol. 2010 Jun 11;141(3):209-13 [PMID 20064670]