30 Pearls of Wisdom that Your Doctor Knows

Hello Heart Sisters,

I have spent many years working alongside doctors and med students, where I have picked up by osmosis many common phrases and 'guidelines' that they tend to use and share when working with patients.

Many of these "pearls” have never been subject to evidence-based testing, but since some appear logical and seem to be helpful, well, they continue to be used and are passed down from doc to med student.

These 30 are from the 'Art of Medicine' section of the program “Clinical Medical Consult” 2009.

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.

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. (but also consider #4.)
14. If it is dry, wet it: if it is wet, dry it.
15. Sutton’s law: 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 being 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.

Interesting, right?

XOXOXO

http://www.myheartsisters.org

By NewAllie
Posted August 23, 2009 at 10:48 am
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Hi Carolyn,
There was another I heard frequently at the teaching hospital I worked at for years, said by the surgeons, residents and fellows, "See one, do one, teach one." Remembering that, my own blatant stupidity in going there for my own heart surgery continues to astound me. No more. Thabnks for the list! Allie

By mysparetimedesign
Posted August 23, 2009 at 10:50 am
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Love this....and by the way can personally attest to number 30!
My youngest was at his father's and he and an older brother were arguing over shutting the window...he solved the noise problem but tearing a piece of wallpaper off the wall and stuffing it into his ear! He was five and it wasn't until two weeks later the problem surfaced, obviously no one told me about it despite the adults at the home trying to remove it on their own....it's a family legacy now and we truly can laugh as it all ended well.
Oh, and I aparently put a plastic purse strap up my nose when I was two....hmmm, family trait?

By Kennarina
Posted August 23, 2009 at 12:18 pm
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Your son had a wad of wallpaper stuffed in his ear for two weeks? That is hilarious!! And the purse strap up your nose? Priceless...

I just thought of another one, when it comes to medications: "Start low, go slow..."

XOXO

http://www.myheartsisters.org

By lkay
Posted August 23, 2009 at 7:04 pm
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my nephew at the age of 3 or so helped himself to the peanuts in the dish on the coffee table... he placed them repeatedly up his nose. We had to take him to the doctor to have them extracted! thanks for bringing back that memory.

btw, the list is great too.

Laura

By vrolijk
Posted August 23, 2009 at 7:07 pm
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Thank you, Kennarina

I loved this post, I had to pass it on to my friend who was a great doctor but was so disgusted with the medical community that she stopped practicing... We lost a great doctor.

Also I had a syncope again two weeks ago when I had shingles. It happened right in the medical center. Of course since my head hit my oxygen tank especially they rushed me to the ER.

Then they sent me up to telemetry, all they did is look at the machines. Figured out there was nothing wrong with me from the machines. Even though they strapped me to the bed never letting me out of the bed and took me in a wheel chair to the car.

Oh, I forgot they wanted me on another Beta Blocker. I am on. Carvedilol. They never even asked me if I had been on other beta blockers before. So this young doctor came out and said Atenolol would be the best for me.

I said Atenolol?? , did you read my history? No answer then again I said I had such low blood pressure with Atenolol and syncope’s also I had cardio enzymes higher than normal because of this beta blocker that they had to take me off and never again to take thismedication ..

Hmm, The young doc left read some more and I left with the same dosage ofcarvedilol.

I wished all doctors could read this maybe I will give it to my PCP who says that my problems are simatic with out the word psycho. Then suggested a psychiatrist… Still would like to know how you can have a heart condition, Shingels, aveolitis, and if you have a syncope how you lower your blood pressure when the ER people that try to help cannot find a pulse……

Thank you for a great laugh, Vrolijk

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