Wednesday, September 21, 2011

Looking for the Zebras

I'm going back to working with medical students tomorrow and thinking about the phrase that I've often heard.

"Common things are common."

When I first heard it, I didn't have a clue what it meant: but what it meant is that if, for example, you have a headache, it's much more likely to be a tension headache than a brain tumour. Tension headaches are very common: brain tumours are rare.

In fact, I did hear a GP say once "Well I know I won't see another brain tumour until I retire, because I've had one patient who had one."

He wasn't being entirely serious, but it's an interesting point. Statistically, he wasn't likely to have another patient with a brain tumour - - but then, statistics, as we know, don't always give the full picture.

It's true, though, that student doctors are taught to look for the likeliest things first, so they don't miss any common illnesses or injuries. And it's the right thing to do in some ways.

However, what it means is that, if you don't quite fit the usual picture, sometimes they will be totally at a loss. And, at other times, they simply won't listen. My best example of this, that happened to me, went like this:

"I'm sure I'm in labour. Absolutely certain."

"No you're not. Don't be silly."

And it was not until the baby arrived that anyone believed me, and even so, nobody ever acknowledged that I'd been right all along, or apologised. Their training - and here it was nurses at fault as well as doctors - taught them that if a woman is in labour, she is also in pain. I wasn't in pain, so they wouldn't listen.

As it turned out I have something unusual wrong with me so I don't feel labour pain and the labour doesn't work too well either. But it was unusual, and nobody was thinking "Perhaps there are exceptions - - "

My friend John told me another version of "Common things are common" the other day which I rather like.

"When you see hoof prints, look for horses, not zebras."

And that is - for much of the time - true.

But if you look for horses, and there ARE no horses - - - well, that's the time to go and find the herd of zebras grazing just behind the clump of trees.


Blogger Jennyta said...

You wouldn't think it would be beyond the wit of intelligent people like doctors and nurses to be able to think outside the box, would you!

7:07 pm  
Anonymous Shooting Parrots said...

I think it also depends on whose medical opinion is being sought.

A friend of mine was on a plane returning from holiday with her GP husband when a passenger fell ill.

The announcement went out: is there a doctor on board. In fact there were three, including him, but the other two were specialists who diagnosed rare tropical diseases rather than the more common condition that it was.

Occam's razor applies!

11:33 pm  
Blogger Ailbhe said...

Heh, yes, my first labour wasn't believed either, because I could speak. Hmph.

12:00 am  
Blogger Debby said...


This should be sent to every doctor in the US and they should have to post it on their walls. THEN they should have to read it daily until they A. Understand it, and B. Believe it!

I'm going to actually steal this phrase next time I go to the doc. Yep, I am.

2:51 am  
Blogger WendyCarole said...

no one believed I was having still labour pains because they were not showing on the monitor. But they did a couple of hours later when my daughter was born 6 weeks prem

10:53 am  
Blogger Yorkshire Pudding said...

When you said "if a woman is in Labour, she is also in pain" were you thinking about Yvette Cooper?

1:32 pm  

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