![]() Therefore, the components that comprised this strange presentation were actually very simple a man with a cough took the wrong tablets by mistake. As the story unfolds, it becomes evident that the man had been self-medicating for a pre-existing viral cough but a pharmacy error had caused an accidental swap between the similar-looking colchicine and his cough medication. Thus the single set of symptoms in this otherwise fit and well man have been met by the rather intellectually lazy pitch of two distinct diagnoses. 4 The eponymous consultant cannot fit the clinical picture together and initially diagnoses two unrelated conditions: a sinus infection and hypothyroidism. In a 2004 episode of the popular US medical drama, House, M.D., a 19-year-old male collapses and presents to hospital with a rather incongruous set of clinical features: hypotension, nausea, a dry cough, abdominal pain and leucopenia. ![]() It is perhaps most eloquently described in Samuel Shem's famous semi-autobiographical novel The House of God, ‘When you hear the beats of hooves, think horses, not zebras’. 2 More recently, the principle has spawned a number of nominal variations including the ‘principle of simplicity’ and the ‘KISS principle’ (Keep It Simple, Stupid). However, Ockham's razor offers us a single diagnosis that fully accounts for this single presentation and guides us to a diagnosis of meningitis - the explanation that requires the fewest number of assumptions.įor centuries, Ockham's razor has proved to be an effective tool for weeding out unfavourable hypotheses and scientists use it every day even when they do not cite it explicitly. Imagine a patient presents to casualty complaining of headache, neck stiffness, fever, and confusion - it is of course perfectly possible that he simultaneously developed a subarachnoid haemorrhage, torticollis, and hepatic encephalopathy. The principle, Numquam ponenda est pluralitas sine necessitate, has over the years been interpreted in a number of ways but is perhaps best translated as ‘Plurality ought never be posed without necessity’- that is, the simplest and most unifying explanation for any given problem is the one most likely to be correct the idea being that other, less satisfactory, explanations are ‘shaven off’ in the process. 1 William of Ockham, its creator, was a Franciscan monk in the early 14th century who studied Theology at the Universities of Oxford and Paris. As such, any assumptions you add to your theory introduce further possibilities for error, and if an assumption isn’t improving the accuracy of a theory, it just increases the probability the theory is wrong.How should the physician react to these challenges in order to correctly diagnose and optimally treat the patient? This article began by stating the principle of parsimony, better known as ‘ Ockham's razor’, (also spelt ‘Occam’). All things can be ascribed a probability of happening. You can think of it in terms of basic probability theory. As medical students are sometimes told, “When you hear hoof beats, think horses, not zebras.” Or as the US Navy KISS design principle states,“Keep it simple, stupid.” ![]() Or if you are a doctor and a patient turns up complaining of a blocked nose, it is more likely they have a common cold than a rare immune-system disorder. If two computer programs do the same job, for example, the shorter one, in which less code can go wrong, is probably preferable. The principle can be applied in many fields of science and logic. ![]() Many other people before and after the friar, including Albert Einstein and Isaac Newton, have come up with similar rules, but it is generally attributed (via an alternative spelling of the name of the village in which he grew up) to Ockham because he used the principle with such razor-like logic to state, along with other things, that “God’s existence cannot be deduced by reason alone.” Occam’s razor is a principle often attributed to 14 th century friar William of Ockham that says that if you have two competing ideas to explain the same phenomenon, you should prefer the simpler one. ![]()
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