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2024, Number 09

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Med Int Mex 2024; 40 (09)

The dilemma in diagnostic reasoning: Ockham’s razor or Hickam’s opinion

Arriaga IDY
Full text How to cite this article

Language: Spanish
References: 11
Page: 603-605
PDF size: 284.98 Kb.


Key words:

Reasoning, Medical education, Causes.

ABSTRACT

The influence of the principle of parsimony (Ockham’s razor) in diagnostic reasoning started from the foundation of modern medical education by Sir William Osler and, until today, it is the most widely used heuristic method in the clinical practice. In this context, the principle proposes that the minimum number of causes that explains all the symptoms and not multiple individual diagnoses should be sought. However, it has been the object of multiple criticisms for its absolute authority in clinical judgment; the main one is Hickam’s dictum that establishes “a patient can have as many diseases as he wants”, emphasizing that more than one disease can be responsible for the signs and symptoms. This paper offers a historical and critical perspective of the dilemma in diagnostic thought that allows it to be used as a tool for reflection in medical action.


REFERENCES

  1. Bleakley A. Blunting Occam’s razor: aligning medical educationwith studies of complexity. J Eval Clin Pract 2010; 16:849-55. 10.1111/j.1365-2753.2010.01498.x

  2. Aron DC. Complex systems in medicine: A hedgehog’stale of complexity in clinical practice, research, education,and management. Springer Nature 2019; 253. DOI:10.1007/978-3-030-24593-1

  3. Kelly J. The diagnostic approach in complex patients: parsimonyor plenitude? Am J Med 2021; 134: 11-2. https://doi.org/10.1016/j.amjmed.2020.08.027

  4. Drachman DA. Occam’s Razor, geriatric syndromes, and thedizzy patient. Ann Intern Med. 2000; 132: 403-5. https://doi.org/10.7326/0003-4819-132-5-200003070-00010

  5. Simić AP, Skrobić OM, Djurić-Stefanović A, Stojakov D, PeškoPM. From Ockham's razor to Hickam's dictum and back—Saint's theory and the insights in herniosis. Eur Surg 2015;47: 9-14. https://doi.org/10.1007/s10353-014-0292-6

  6. Mani N, Slevin N, Hudson A. What three wise men haveto say about diagnosis. BMJ 2011; 343: d7769. 10.1136/bmj.d7769

  7. Whyte MB. An argument against the use of Occam’s razorin modern medical education. Med Teach 2018; 40: 99-100.10.1080/0142159X.2017.1309379

  8. Redelmeier DA, Shafir E. The fallacy of a single diagnosis.Med Decis Making 2023; 43: 183-90. https://doi.org/10.1177/0272989X221121343

  9. Hilliard AA, Weinberger SE, Tierney LM, Midthun DE, SaintS. Occam’s razor versus Saint’s triad. N Engl J Med 2004;350: 599-603. https://doi.org/10.1056/NEJMcps031794

  10. Hauer-Jensen M, Bursac Z, Read RC. Is herniosis the singleetiology of Saint’s triad? Hernia 2009; 13: 29-34. 10.1007/s10029-008-0421-x

  11. Wardrop D. Ockham’s razor: sharpen or re-sheathe? J R SocMed 2008; 101: 50-1. 10.1258/jrsm.2007.070416




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Med Int Mex. 2024;40