| Identifier |
occams_razor_vs_hiccums_dictum |
| Title |
Occam's Razor vs Hiccum's Dictum |
| Creator |
Andrew G. Lee, MD; Sugi Panneerselvam |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (SP) Class of 2022, Baylor College of Medicine, Houston, Texas |
| Subject |
Occam's Razor; Differential; Diagnosis |
| Description |
Summary: • Occam's Razor: The simplest explanation unifying the history and physical is often the most accurate diagnosis. o Combine a long list of symptoms and signs using a simple diagnosis • Hiccum's Dictum: A patient can have more than one problem explaining signs and symptoms |
| Transcript |
I followed Dr. Lee in clinic for the past few weeks and often times you mentioned this theorem of "Occam's Razor." Can you speak a little bit about how that applies to the medical field and specifically your practice? So, in my practice I'm often confronted with patients with very complex and long histories and one of the things I like to do is make it as simple as possible, but no simpler. And by that I mean we'd like to get to a single unifying diagnosis, if we can, and the problem with modern medicine is you are bombarded with too much information-- the electronic medical record has too much information, and so it's very easy as a beginning learner in medicine to get distracted by all sorts of things that have nothing to do with the case. However, if we can simplify the problem list and try and get to a single unifying mechanism and ultimately a single unifying diagnosis, the simplest answer is usually the correct answer, and that is what we mean by "Occam's razor." We are using the razor to shave away all the distractions and just leaving us with a single unifying diagnosis. For example, in a patient who has the following problems: a 35-year-old white female presents with a red eye, and then she gets a bulging red eye, and then she gets double vision, and then she gets loss of vision. It's easy to get distracted by that long laundry list of complaints. However, the most common cause of acute unilateral or bilateral proptosis and adults it's actually thyroid eye disease, and so if we can make the red eye horizontal muscle injection, if we can make the proptosis from extracting a muscle margin, if we can make the double vision her motility deficit, if we can make the loss of vision from an optic neuropathy (a compressive optic neuropathy), then we'll have a single unifying diagnosis that will explain all of this patients symptoms and signs. So, instead of just having a laundry list of symptoms or complaints or problems-- red eye, bulgy eye, double vision, loss of vision, optic neuropathy-- we would try and look at the case and make a single unifying diagnosis. And in that person's case, we try to make it in the orbit, causing compression, causing diplopia and a red eye, and that means linking the things together with the Razor. And so, Occam's Razor would dictate that thyroid ophthalmopathy would be a better single unifying diagnosis for that constellation or sequence of problems. And then we do the same thing with the HPI and we do the same thing with the focus stem in the chief complaint. So, if you haven't watched those videos, you should as well. So, we need to go from a chief complaint, to an HPI, to a focused stem, to a single unifying diagnosis or mechanism. And the razor means having a simple explanation is best and a single explanation. But some patients have multiple problems, and so that's Hiccum's Dictum, which is the opposite of Occam's Razor: a patient can have as many diseases as they pleases. But in general, you prefer the Razor to Hiccum's Dictum. |
| Date |
2019-10 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6mm14dq |
| Setname |
ehsl_novel_lee |
| ID |
1469310 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6mm14dq |
