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Medical Axioms: The Pithy Little Sayings That Reflect Deeper Knowledge

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I love axioms. Perhaps it is the result of hearing them from one of my earliest mentors in medical school. Or perhaps it is the result of advice given me by my journalist/English teacher mother who told me that everything you write can be improved by condensation. Whatever the underlying reason, I continue to collect and remember these pithy little sayings and pass them on to my trainees who are probably getting tired of hearing them on a daily basis!! In the slang of daily rounds, these axioms are often referred to as “pearls.” Since the advent of Twitter communication, many individuals throughout the world have come to admire condensed messages, some of which convey a considerable amount of information in a limited number of words. Recently, Mark B. Reid, MD, a hospitalist working in Denver, sent me a small book that he had authored which contained many of his favorite personal axioms as well others taken from the long history of medicine.1 One of my favorite axioms that I like to cite on rounds is “Perfect is the enemy of good.” What I mean by this is that the specific patient we are discussing is improving steadily and does not need a great deal more diagnostic and therapeutic intervention. I usually add “Let’s stay the current course, and see how things develop.”

I thoroughly enjoyed Dr. Reid’s collection of axioms, some of which are definitely satirical in nature and represent clinical observations gained over a long career. Here are some of my favorites, with a few of my own comments included:

  • 1. “Everybody lies to cops. The less you act like a cop, the less you will get lied to.” I agree with this axiom. One needs to approach the bedside radiating confidence and friendship if you want to get an accurate history. This is the reason that medical students sometimes get information from patients that was not disclosed to the residents or the attending.
  • 2. “There is no health in the body while there are bad teeth in the mouth.” I agree and discussed this issue in an earlier editorial.2 
  • 3. “Even the best doctors make mistakes. Only the best doctors want to hear about them.” My recent editorial on learning from our mistakes agrees with this axiom from Dr. Reid.3 
  • 4. “Every day a patient spends in the hospital bed takes a week to recover,” and “A healthy person put in a hospital bed for a week will get sick with something.” This is the reason that I am constantly urging my inpatients to get out of bed and walk around the ward. I tell them that lying in bed is like being an astronaut in outer space. When you return to earth, you feel terrible! I also enjoy asking my residents to list 10 bad things that can happen from prolonged bed rest. By the way, it turns out that there are more than 10.
  • 5. “No patient wants a hurried doctor—speed up between patients and slow down with them.” This axiom is hard to live by in the current clinical/economic environment. But, we have to try to listen to everything our patients want to tell us and not constantly interrupt them in an attempt to shorten the visit.
  • 6. “The problem is not that doctors think they are gods. The problem is that some patients expect us to be.” I have experienced this myself when families expect you to save a terribly ill patient. Rarely you succeed, but usually you fail. It can occasionally be hard for families to accept this failure.
  • 7. “Know your Achilles heel. Mine is sputum.” My Achilles heel is obesity. I try hard not to ask the patient why they cannot lose weight when it is so important for their health.
  • 8. “Electronic Health Record: An expensive contraption that makes the ancient practice of ministering to the sick into a video game.” We have all experienced the minuses (and some pluses) of the electronic medical record (EMR). I have yet to meet a colleague who told me that it took less time to write an initial history and physical or progress note using the EMR. It always takes longer than it used to.
  • 9. “Learn how to fetch a blanket and fill the water pitcher.” Patients very much appreciate the physician who is willing to do small favors for them.
  • 10. “Irrespective of diagnosis, 99% of patients admitted after 10 PM would like a turkey sandwich.” I frequently tell the residents that we are experts at starving people! I often go to the floor refrigerator to get a patient something to eat or drink. Patients will love you for simple actions like this.

 

This little book is full of many more sayings, including some very funny ones not quoted here. The book ends with a number of axioms quoted from earlier well-known medical authorities such as Sir William Osler. Here are several that I particularly liked:

“The lesser the indication, the greater the complication.” This quotation is from the pioneer surgeon, William Halsted (1852-1922). I have seen this saying proven true many times. It leads me to suggest as few invasive diagnostic tests or procedures as possible.

“It is difficult to make the asymptomatic patient feel better.” (Stanley O. Hoerr, 1909-1990). My mentor, Lewis Dexter, stated this axiom frequently when we were suggesting operative closure of an atrial septal defect for a patient. Most of these patients say they are asymptomatic.

“Teach thy tongue to say ‘I don’t know’.” (Maimonides b. 1135). Younger doctors often have a hard time saying this short sentence.

As always, I am happy to hear from readers on our blog at amjmed.org.

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-Joseph S. Alpert, MD

This article originally appeared in the July issue  of The American Journal of Medicine.

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