Anti-maxims

Examples of typical errors in bold

"No man’s opinions are better than his information"
Paul Getty

Making a diagnosis of stroke by only examining one side of a patient's body and later finding out that they are weak on both sides of their body.

"A few observations and much reasoning leads to error; many observations and a little reasoning to truth"
Alexis Carrell

Forgetting that identifying the cause of leg pain involves more than examining muscles and joints (MSK pain) but includes testing sensation (neuralgic pain) and checking pulses (ischaemic pain)

"Never believe what a patient tells you his doctor has said."
William Jenner

Accepting the label of a diagnosis or self diagnosis e.g. 'heart attack' despite further investigation of the case record showed they previously had normal serial troponins, normal stress test and normal coronary angiogram.

"If you don’t ask, you won’t know"
Anon

A teenager with pelvic pain may not volunteer they have a vaginal discharge, sexually active and find it painful during intercourse.

A person with shortness of breath may forget to mention they had a pulmonary embolus 20 years ago since they are no longer on treatment.

"If you listen carefully to the patient they will tell you the diagnosis"
Sir William Osler

A few well chosen opening questions and encouraging phrases may be better than barging in with lots of questions and stop patients revealing the more embarrassing or interesting parts of the history.

‘You know my method. It is founded upon the observation of trifles’
Sherlock Holmes

Missing the track marks on a patient with unexplained fever prevents you from considering endocarditis.

If you don’t think of the diagnosis you’ll never make it.
Anon

You won't do a gynaecological assessment or pregnancy test if you don't consider causes of right iliac fossa pain apart from appendicitis.

"More is missed from not looking than not knowing"
Prof. Thomas Macrae

A slap dash, unsystematic physical exam causes you to miss testicular torsion for the cause of lower abdominal pain ('the routine abdominal exam extends below the inguinal ligament')

"You see only what you look for; you recognise only what you know"
Dr. Merrill Sosman

You confuse the appearance of cholesteatoma (a rare condition that leads to permanent deafness) with otitis media (a common condition that usually responds to treatment)

"If there is a fault in us bred of familiarity it is, I believe, the old fault of omitting to probe sufficiently deeply into causes; the fault of accepting the fact of common symptoms without trying to explain them."
Jon A Ryle

You make the assumption that the alcoholic with epigastric pain has got pancreatitis but fail to obtain the history that he is a heavy smoker with a strong family history of cardiac disease.

"Discard in the first instance all attempts to identify or to name, and try instead to read the malady, tracing the symptoms to the seat of their cause, and discerning the nature of the morbid process by their character and course.
Sir William Gowers

You focus on serious cardiac causes for after a patient collapses and dismiss her complaints of sore eye as minor bruising. However, the actual story is that the eye was painful a day beforehand (vision threatening acute angle closure glaucoma requiring emergency treatment) causing them to faint. A better examination of the eye reveals the pathology.

"Uncommon presentations of common diseases are more common than common presentations of uncommon diseases"
Unknown

You are preoccupied with diagnosing an exotic tropical illness in an returned traveler when the most likely cause for a fever is going to be either a common viral or bacterial infection.

"When disease takes an unexpected turn, or treatment after due trial proves ineffective, reconsider the diagnosis"
Unknown

The treatment for acute COAD that isn't getting better is not more salbutamol but to have another look at the CXR and put a chest drain in for the pneumothorax that you missed.

"The greater the ignorance, the greater the dogmatism."
Sir William Osler

Just because you have never seen the problem or read about it doesn't mean that it doesn't exist. Even more so if you are a specialist.

"Experience is the ability to repeat the same mistakes over and over again with ever increasing confidence"
Anon

Patients don't come back to see you because you did a good job. They don't come back because you did a bad one. Following up your cases and verifying your outcomes with colleagues is the only way you know you are doing the right thing.

Good judgment comes from experience. Experience comes from bad judgment.
Mulla Nasrudin

Except if you have never learned from your bad judgment (or never realised it was bad in the first place)

"Men mark when they hit, and never mark when they miss"
Francis Bacon

Good outcomes are due to dumb luck. Bad outcomes are because of you relying on it..

"The value of experience is not in seeing much, but in seeing wisely."
Sir William Osler

You perform a thorough screening GI examination for a person with unexplained abdominal pain but their loose waistband gives away the cause of the problem.

"Medicine is a science of uncertainty and an art of probability."
Sir William Osler

A judgement call works best when you have as much accurate information as humanly possible - otherwise it is like throwing dice.

"It is much simpler to buy books than to read them and easier to read them than to absorb their contents."
Sir William Osler

A patient with a high CHAD2 score is a great candidate for warfarin (unless they have uncontrolled hypertension, a history of GI bleeding and a recent subdural haematoma from recurrent falls). Every 'proven' treatment has side effects and complications. (all known knowledge is contigent and has qualifiers)

‘In my experience’ - I have seen it once
‘Time and time again’ - I have seen it twice
‘In a small case series’ - I have seen it three times

"A man must cultivate the habit of careful observation and of cautious thinking"
Paget

Just because the last ten headaches you have seen responded to migraine treatment doesn't meant that today your patient isn't having a sub-arachnoid haemorrhage.

"Life is short, and the art is long."
Hippocrates

Not, medical school was short and my debt is long.