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Clinical Tips
Published in John Larkin, 101 Top Tips in Medicine, 2021
It’s possible that many of you have no idea what Occam’s Razor is – despite the fact you almost certainly use it daily in your diagnostic deliberations. It is often described – e.g. in Wikipedia (this week anyway) – as the ‘wish to come up with a unifying diagnosis that will explain all of the patient’s problems’. All very laudable. But it ain’t perfect.
Attention-Deficit Hyperactivity Disorder
Published in Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick, Peter Hill, David Hall, Jackie Carnell, Child Mental Health in Primary Care, 2018
Quentin Spender, Niki Salt, Judith Dawkins, Tony Kendrick, Peter Hill, David Hall, Jackie Carnell
Comorbidity can be a source of confusion, as a large variety of conditions may coexist with attention-deficit hyperactivity disorder. This is partly because this situation offends the ‘Occam’s razor’-like principle that is taught in medical school – never to use two diagnoses when one will do. In fact, comorbidity is common in attention-deficit hyperactivity disorder, the most likely candidate being some form of behaviour disorder. In the past, this has resulted in attention-deficit hyperactivity disorder being misdiagnosed as conduct disorder or oppositional defiant disorder. There is a strong association between the two groups of conditions, but research clearly demonstrates they are two distinct dimensions.
Glossary
Published in Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh, Diagnosis, 2017
Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh
Occam’s razor: the dictum that the simplest explanation is likely the best. In medicine, this principle argues that a single diagnosis should be sought to account for most, if not all, the symptoms and problems a patient has.
Proposed mechanism of action of tap water iontophoresis for treatment of hyperhidrosis
Published in Cogent Medicine, 2018
The mechanism proposed here should not be readily visible with light microscopy, since the lumen is being plugged with the very substances that are naturally secreted into the lumen by the sweat gland itself, explaining why previous studies found no change in the sweat duct before vs. after treatment (Hill et al., 1981). It may, however, be possible to visualize jammed nanoparticles within the lumen of the duct, if they exist, using ex situ electron microscopy, atomic force microscopy, or X-ray scattering (Lin et al., 2005). The mechanism that I have proposed is, admittedly, rather complicated. Occam’s razor requires that simpler explanations be accepted over more complicated explanations. As indicated above, studies have failed to support previous simpler explanations, and each of the individual biological, chemical, and physical components of the proposed mechanism have been thoroughly demonstrated more generally, and it is only their individual and combined application to the effects of iontophoresis that remain untested.
Hickam’s Dictum: Pseudoxanthoma elasticum and Usher syndrome in a single patient
Published in Ophthalmic Genetics, 2020
Kevin Wang, Brittney Statler, Michael Ramos, Meghan J DeBenedictis, Amy Babiuch, Alex Yuan, Elias I. Traboulsi
Occam’s razor is the reductionist principle that “entities should not be multiplied without necessity”. In clinical practice, Occam’s razor is applied by choosing the simplest and most unifying diagnosis to explain a patient’s physical abnormalities. Contrary to this are Saint’s Triad and Hickam’s Dictum. South African surgeon Charles F.M. Saint observed that patients with atypical abdominal pain often had concurrent cholelithiasis, hiatal hernia, and diverticulosis without a unifying explanation. Saint used the triad to emphasize to medical students that more than one disease can explain a patient’s presenting signs and symptoms. Less elegantly, American physician John Hickam summarized this best by stating, “A man can have as many diseases as he damn well pleases”.
An argument against the use of Occam’s razor in modern medical education
Published in Medical Teacher, 2018
Ironically, the principle of Occam’s razor is often itself reduced to the general ordinance that the simpler theory is more likely to be the correct one. It takes little effort to see how this definition could be wrong: planetary orbits would be circular rather than elliptical, epigenetics would not be necessary as DNA sequence explains transfer of genetic material and more prosaically, bacterial superinfection would not be considered as a debilitating progression of viral influenza.