Friday, November 03, 2006

The answer is never no
(you never know what you're missing)

On my teaching service, I would often ask a student, resident or fellow if they had ever seen a case of a certain disease. Some would answer that they had while most would say, "no." I would respond to the no-sayers with, "How do you know that?"

They would often appear perplexed, so I would ask if they knew how many toes the patient we were about to examine had. Even though the young doctor had already examined the patient in preperation for out session, he or she would almost invariably start to reach for the covers at the foot of the bed. They were sure that this patient had 9 or maybe 11 toes and that they had missed it, otherwise, why would I be making such a big deal over such a small thing? At this point, I would stop them from looking and stop the torture.

I would explain that I was certain that they knew how to count toes and that if they didn't know how many the patient had it was due to having not counted them. The lesson was that the most common error in medicine (and I suspect in other aspects of life...no digression here) is the error of omission. If I don't ask the question or look and count, I can't know one way or the other. That leads us to the title of this blog, you can't say no.

When asked if you've ever seen a rare disease, the only possibly correct answers are 1, yes, I have or 2, not to my knowledge because answering "no" infers an infallibility. To say no means you are sure you never saw and missed the diagnosis of the disease, and such thinking can be dangerous, especially in medicine.

They say there are two types of bike riders, those that have fallen and those who will. I am sure you can come up with a similar adage around paddling. But, first, let me ask you something: Have you ever, while kayaking, done something that almost got you killed? (Not so fast...).

Paddle safe...

DS

5 comments:

derrick said...

I exist, therefore I'm doing something can get me killed. Every moment of every day - great post. .

Buncher said...

What is that a picture of?

Silbs said...

The "picture" is a lateral (side view) chest x ray. The white is barium in the patient's esophagus (the breast shadows on the lower left tell us it is a female...but I digress...even here). The LA is the left atrium of the heart which is poking agains the esophagus because the atrium is enlarged due to mitral valve stenosis (not opening widely enough) causing back pressure into the atrium. But you all probably knew that already.

Alex said...

Nice post Dick. In whitewater there is the common phrase "we are all between swims" regarding missing a roll and having to swim or being forced to do so due to the river environment (hole, strainer, pin, etc.)

JohnB said...

Yep, what he said. . .