Aa
Horses instead of Zebras
I read this is the medical school mantra: “When you hear hoofbeats, think horses, not zebras.”
Has anyone heard this before?
Okay, it is clear why patients can feel dismissed, but I wonder why if you hear hoofbeats and there are no horses but you see stripes, why not consider zebras?????
Maybe Quix can weigh in here at some point and explain when doctors decide to consider those zebras.
Wanna
Has anyone heard this before?
Okay, it is clear why patients can feel dismissed, but I wonder why if you hear hoofbeats and there are no horses but you see stripes, why not consider zebras?????
Maybe Quix can weigh in here at some point and explain when doctors decide to consider those zebras.
Wanna
This is an interesting discussion, and kinda wacky too. They're the best kind.
The neuro back from my present one had me tested for cancer antibodies that were mistakenly attacking my CNS. This does happen, but it's very rare. He also said I had cerebellar degeneration. Of course he's also the one who didn't look at my MRIs either. My new neuro did a few more confirming tests and put me on Copaxone within 2 weeks.
ess
The neuro back from my present one had me tested for cancer antibodies that were mistakenly attacking my CNS. This does happen, but it's very rare. He also said I had cerebellar degeneration. Of course he's also the one who didn't look at my MRIs either. My new neuro did a few more confirming tests and put me on Copaxone within 2 weeks.
ess
I concur!!!!!!!!! You have found a *&^^*(()**^!!!!!!!! LOL!!
Good luck tomorrow and tell him this
"Oh, did I tell you I used to eat Human beings for breakfast? I must have forgotten to mention that one"
This guy sounds a bit crackish, maybe he just needs an SSRI!!! LOL
Good luck tomorrow and tell him this
"Oh, did I tell you I used to eat Human beings for breakfast? I must have forgotten to mention that one"
This guy sounds a bit crackish, maybe he just needs an SSRI!!! LOL
I'm dead serious....He specifically said that disease to me, along with CJD (Creutzfield Jakob) and a couple other Prion diseases....I even saw it on my labwork from the LP...They look for a 14-3-3 protein which shows up in Prion diseases....
Whatever the heck all that means! LOL
He also check for TB, Meningitis, Cancer, Syphillis,....can't remember what else...
He seems to be absolutely FIXATED on my CENTRAL sleep apnea for some reason, as well....(I have lesions on my Pons as well which controls autonomic functions, which is why I stop breathing every night when I sleep)
That's it....I'm changing his name from Dr. OTF to *******!!! LOL
Whatever the heck all that means! LOL
He also check for TB, Meningitis, Cancer, Syphillis,....can't remember what else...
He seems to be absolutely FIXATED on my CENTRAL sleep apnea for some reason, as well....(I have lesions on my Pons as well which controls autonomic functions, which is why I stop breathing every night when I sleep)
That's it....I'm changing his name from Dr. OTF to *******!!! LOL
OK, let me get this straight because I am not sure I read that right . . . . . .
Doctor OTF is ready, willing, and able to test you for a rare cannibalistic New Guinean disease BUT is NOT willing to say you have what every other test points that you have??????
Am I losing it or does this sound weird?
Kristin
Doctor OTF is ready, willing, and able to test you for a rare cannibalistic New Guinean disease BUT is NOT willing to say you have what every other test points that you have??????
Am I losing it or does this sound weird?
Kristin
I did hear that term when my dr dx'd me w/AOSD, he said I had a zebra in my backyard instead of a horse. He has not seen many zebras in his career and took a particular interest in my case. I knew I was in great hands when he said this is what you have and this is how we are going to treat it. It was strange to hear that tonite. I had completely spaced it off.
Spazie Ada
Spazie Ada
You know what's funny, though? My Neuro tested me for some pretty bizarre Prion diseases with my spinal fluid (zebra), but can't commit to MS (horse)????
And when I say bizarre, I mean bizarre!!
There was one called "Kuru" which I later researched and ewwwwww.....the way this disease came to be was through a cannibalistic ritual at funerals in New Guinea or something like that....
(not bashing anyone's rituals, but.......)
Should I then take this to believe that my Neuro is a Zebra chaser or just a complete wacko??
Tammy
And when I say bizarre, I mean bizarre!!
There was one called "Kuru" which I later researched and ewwwwww.....the way this disease came to be was through a cannibalistic ritual at funerals in New Guinea or something like that....
(not bashing anyone's rituals, but.......)
Should I then take this to believe that my Neuro is a Zebra chaser or just a complete wacko??
Tammy
Yup! You guys nailed it. Medical students have to learn and memorize all of the common stuff right along with all of the really uncommon, striped stuff; even the diseases that have only been described a few times in history. So when they get on the hopsital rotations and start learning the "Art of Diagnosis and Motorcycle Maintenance" the zebras are fresh in their heads and they go off on wild tangents all the time. The next 3 or so years is spent learning to see what is common and what is not.
The follow up mantra is "Common things are Common." Then things get a little sloppy sometimes. There is a lot of arrogance and rigidity in the doctors that become full-time professors. They sometimes to be more narrow-minded and less creative as they get older. This rubs off on the residents. The best doctor/teachers, I found, were the ones who taught and also continued to practice actively. They were more in touch with life.
It is very true that in the time crush of practicing medicine that doctors think less and less about the zebras in the world. The broader the field of knowledge they practice in the less likely they seemed to be able to recognize variations from the normal way diseases present. I found that Family Practitioners missed a lot of the more unusual pediatric diseases. Remember, I practiced Peds for 23 years and was the specialist backup for FP's for the majority of those years.
Then there is the insidiously growing comfort with dismissing anything that isn't readily diagnosable as noraml, anxiety, depression, or hysteria - especially in women. But, it happens to men all the time also, usually more often by the male subspecialists, like neurologist and sturgeons. Arrogance and even dislike of women is institutionalized in a lot of medical training. Keep in mind here that I trained 30 years ago, but my last exposure to academic medicine was 1988 to 1997. The tendency to disbelieve and marginalize women was still present then.
The third dogma that doctors try to follow is: "Always attempt to explain all of the patient's symptoms and physical signs with a single diagnosis." This is a valuable place to start when you approach a conplicated patient. This approach keeps your thinking logical and tight. It also fosters the examination of any zebras who poke their noses in while you try to expain things simply. In fact, this philsophy is well represented on the TV show House in the conference room discussions with the white board.
The problems come when the doctor is not able to imagine a dual (or more) diagnosis. These doctors are rigid thinkers and when a symptom, test result, or exam finding falls outside their "one diagnosis" they tend to dismiss it as irrelevant, feigned, or even deny its existence. We have see examples of all of these here on the forum. Who was it that had a neurologist believe her lower extremity symptoms, but told her her upper extremity symptoms were a conversion reaction. WTF???!!!!
And then there is, "If it Looks like a Duck, Quacks like a Duck, has Ducklings following behind it, it is very likely a DUCK! Even if it is found among a herd of Blue-Footed Boobies!
Funny story: I had just moved from Arizona to Chicago. It was September, and one of my first patients had a very severe and rapid onset of horribly painful, spreading muscle spasms and abdominal pain. None of the residents could figure it out. I came in, took a history, examined her and confidantly made the diagnosis of Black Widow Sider bite and began the appropriate symptomatic therapy. After all I had just spent three years in the desert on an Indian Reservation and routinely treated rattlesnake and black Widow bites and scorpion stings. It was pretty much a no-brainer. I have to say, though, that it was easier to make this diagnosis because I didn't know that there are no Black Widow Spiders in Chicago!! (Ooooops...) They cannot survive the winters. My colleagues were laughing at me.
So we had a big conference call involving 4 or 5 Poison Control Specialists from all over the US. After a thorough analysis of the case they concluded that the patient's course could ONLY be from a BWS bite. Then I called the Field Museum of Natural History and found out that a couple times a year in the warmer months someone would bring in a BWS for identification. Their explanation was that the spider likely hitched a ride in a cargo of something shippred from their normal habitat, and would hang around causing mayhem until the winter when the cold killed them.
Upshot? Ignorance is Bliss and you have to keep the Zebras running through your head at all times. Maybe it's not tinnitus, maybe it's those darn zebras...And, BTW - MS is not a zebra as someone noted.
Quix
The follow up mantra is "Common things are Common." Then things get a little sloppy sometimes. There is a lot of arrogance and rigidity in the doctors that become full-time professors. They sometimes to be more narrow-minded and less creative as they get older. This rubs off on the residents. The best doctor/teachers, I found, were the ones who taught and also continued to practice actively. They were more in touch with life.
It is very true that in the time crush of practicing medicine that doctors think less and less about the zebras in the world. The broader the field of knowledge they practice in the less likely they seemed to be able to recognize variations from the normal way diseases present. I found that Family Practitioners missed a lot of the more unusual pediatric diseases. Remember, I practiced Peds for 23 years and was the specialist backup for FP's for the majority of those years.
Then there is the insidiously growing comfort with dismissing anything that isn't readily diagnosable as noraml, anxiety, depression, or hysteria - especially in women. But, it happens to men all the time also, usually more often by the male subspecialists, like neurologist and sturgeons. Arrogance and even dislike of women is institutionalized in a lot of medical training. Keep in mind here that I trained 30 years ago, but my last exposure to academic medicine was 1988 to 1997. The tendency to disbelieve and marginalize women was still present then.
The third dogma that doctors try to follow is: "Always attempt to explain all of the patient's symptoms and physical signs with a single diagnosis." This is a valuable place to start when you approach a conplicated patient. This approach keeps your thinking logical and tight. It also fosters the examination of any zebras who poke their noses in while you try to expain things simply. In fact, this philsophy is well represented on the TV show House in the conference room discussions with the white board.
The problems come when the doctor is not able to imagine a dual (or more) diagnosis. These doctors are rigid thinkers and when a symptom, test result, or exam finding falls outside their "one diagnosis" they tend to dismiss it as irrelevant, feigned, or even deny its existence. We have see examples of all of these here on the forum. Who was it that had a neurologist believe her lower extremity symptoms, but told her her upper extremity symptoms were a conversion reaction. WTF???!!!!
And then there is, "If it Looks like a Duck, Quacks like a Duck, has Ducklings following behind it, it is very likely a DUCK! Even if it is found among a herd of Blue-Footed Boobies!
Funny story: I had just moved from Arizona to Chicago. It was September, and one of my first patients had a very severe and rapid onset of horribly painful, spreading muscle spasms and abdominal pain. None of the residents could figure it out. I came in, took a history, examined her and confidantly made the diagnosis of Black Widow Sider bite and began the appropriate symptomatic therapy. After all I had just spent three years in the desert on an Indian Reservation and routinely treated rattlesnake and black Widow bites and scorpion stings. It was pretty much a no-brainer. I have to say, though, that it was easier to make this diagnosis because I didn't know that there are no Black Widow Spiders in Chicago!! (Ooooops...) They cannot survive the winters. My colleagues were laughing at me.
So we had a big conference call involving 4 or 5 Poison Control Specialists from all over the US. After a thorough analysis of the case they concluded that the patient's course could ONLY be from a BWS bite. Then I called the Field Museum of Natural History and found out that a couple times a year in the warmer months someone would bring in a BWS for identification. Their explanation was that the spider likely hitched a ride in a cargo of something shippred from their normal habitat, and would hang around causing mayhem until the winter when the cold killed them.
Upshot? Ignorance is Bliss and you have to keep the Zebras running through your head at all times. Maybe it's not tinnitus, maybe it's those darn zebras...And, BTW - MS is not a zebra as someone noted.
Quix
WHAT AN EXCELLENT EXPLANATION.
I'M GREATFUL FOR MY NEURO,HE JUMPED OUT OF THE BOX WHEN MY REFLEXES IN MY LEGS WENT FROM HYPER TO HYPO,HE TOLD ME HE WANTED A LUMBAR MRI IMMEDIATLY,I'M THINKING WHAT FOR.HE WAS LOOKING FOR ARACHNOIDITIS.
WHEN HE GOT THE LUMBAR MRI REPORT,HE CALLED ME AND SAID YOU HAVE ADHESIVE ARACHNOIDITS BILATERALLY.A RARE NERVE DISEASE.
I WISH MORE HAD NEURO'S LIKE MINE,HE'LL LOOK FOR THAT ZEBRA AND TRY TO TAME IT.
T
I'M GREATFUL FOR MY NEURO,HE JUMPED OUT OF THE BOX WHEN MY REFLEXES IN MY LEGS WENT FROM HYPER TO HYPO,HE TOLD ME HE WANTED A LUMBAR MRI IMMEDIATLY,I'M THINKING WHAT FOR.HE WAS LOOKING FOR ARACHNOIDITIS.
WHEN HE GOT THE LUMBAR MRI REPORT,HE CALLED ME AND SAID YOU HAVE ADHESIVE ARACHNOIDITS BILATERALLY.A RARE NERVE DISEASE.
I WISH MORE HAD NEURO'S LIKE MINE,HE'LL LOOK FOR THAT ZEBRA AND TRY TO TAME IT.
T
Thanks. Good job girl.
This is a quote from that site...
"In the medical community, the term “zebra” is commonly and universally understood as a reference to a rare disease or condition. Physicians are taught to assume that the simplest explanation is usually the best, so as not to go around diagnosing patients with all sorts of exotic illnesses that are highly unlikely. Common diseases are what physicians should expect to encounter.
But those who actually do have a rare disorder know firsthand that some physicians seem to have completely lost the ability to imagine that zebras may exist! It is frustrating indeed, to spend years being shuffled from specialist to specialist, seeking diagnosis and treatment for an unidentified condition."
The key here is RARE.
Now to convince the general medical community that MS and other autoimmune disease are not rare (zebras).
Wanna
This is a quote from that site...
"In the medical community, the term “zebra” is commonly and universally understood as a reference to a rare disease or condition. Physicians are taught to assume that the simplest explanation is usually the best, so as not to go around diagnosing patients with all sorts of exotic illnesses that are highly unlikely. Common diseases are what physicians should expect to encounter.
But those who actually do have a rare disorder know firsthand that some physicians seem to have completely lost the ability to imagine that zebras may exist! It is frustrating indeed, to spend years being shuffled from specialist to specialist, seeking diagnosis and treatment for an unidentified condition."
The key here is RARE.
Now to convince the general medical community that MS and other autoimmune disease are not rare (zebras).
Wanna
Hiya!
Yes, I have definitely heard this saying before regarding doctor's and making diagnosis'.
I think it's called the Occam's Razor Principle, or something like that....
Check it out here:
http://www.medrants.com/index.php/archives/2315
I just looked it up! :)
Tammy
Yes, I have definitely heard this saying before regarding doctor's and making diagnosis'.
I think it's called the Occam's Razor Principle, or something like that....
Check it out here:
http://www.medrants.com/index.php/archives/2315
I just looked it up! :)
Tammy
NO WONDER DRS. ARE SO DISMISSIVE,MAYBE THEY SHOULD OF BECOME VETANARIANS INSTEAD OF MDS.
I THINK WHAT THEY ARE SAYING IS IF THE SYMPTOMS DON'T MATCH THE PHYSICAL EXAM,THEN ITS A ZEBRA INSTEAD OF A HORSE.
INSTEAD OF SEARCHING FOR ANSWERS,THEY ARE LOOKING AT PATIENTS BEING DX'D AS ANXIETY,STRESS AND DEPRESSION THE CAUSE.OR SAMOTASIZING(SP) THEIR SYMPTOMS.
MANY DRS. TODAY ARE SO OVER BOOKED THAT ITS TAKING 4,5,6,7 DIFFERENT DRS. TO FIND A DR THAT WILL BE WILLING TO LOOK AT AN ACTUAL CAUSE.
MANY DRS. ARE PUSHING PAITENTS THROUGH THEIR OFFICES AS CATTLE GOING TO MARKET.NOT ALL DRS.BUT MANY DRS.HAVE SCHEDULED PATIENTS 15 MINUTES APART.
BUT I AGREE,WHY NOT A ZEBRA, MY REFLEXEX FROM THE WASTE DOWN DON'T MATCH MS,THEY ARE HYPO, NOT HYPER DO TO ADHESIVE ARACHNOIDITIS,MY ORIGINAL VEP IN APRIL OF 2006 WAS NORMAL,IN NOVEMBER 2007,BOTH EYES ABNORMAL.
MAYBE QUIX WILL HAVE THE ANSWERS
T-LYNN
I THINK WHAT THEY ARE SAYING IS IF THE SYMPTOMS DON'T MATCH THE PHYSICAL EXAM,THEN ITS A ZEBRA INSTEAD OF A HORSE.
INSTEAD OF SEARCHING FOR ANSWERS,THEY ARE LOOKING AT PATIENTS BEING DX'D AS ANXIETY,STRESS AND DEPRESSION THE CAUSE.OR SAMOTASIZING(SP) THEIR SYMPTOMS.
MANY DRS. TODAY ARE SO OVER BOOKED THAT ITS TAKING 4,5,6,7 DIFFERENT DRS. TO FIND A DR THAT WILL BE WILLING TO LOOK AT AN ACTUAL CAUSE.
MANY DRS. ARE PUSHING PAITENTS THROUGH THEIR OFFICES AS CATTLE GOING TO MARKET.NOT ALL DRS.BUT MANY DRS.HAVE SCHEDULED PATIENTS 15 MINUTES APART.
BUT I AGREE,WHY NOT A ZEBRA, MY REFLEXEX FROM THE WASTE DOWN DON'T MATCH MS,THEY ARE HYPO, NOT HYPER DO TO ADHESIVE ARACHNOIDITIS,MY ORIGINAL VEP IN APRIL OF 2006 WAS NORMAL,IN NOVEMBER 2007,BOTH EYES ABNORMAL.
MAYBE QUIX WILL HAVE THE ANSWERS
T-LYNN
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