And by that I mean we'd like to get to a single unifying diagnosis, if we can, and the problem with modern medicine is you are bombarded with too much information- the electronic medical record has too much information, and so it's very easy as a beginning learner in medicine to get distracted by all sorts of things that have nothing to do with the case. However, if we can simplify the problem list and try and get to a single unifying mechanism and ultimately a single unifying diagnosis, the simplest answer is usually the correct answer, and that is what we mean by "Occam's razor." We are using the razor to shave away all the distractions and just leaving us with a single unifying diagnosis. For example, in a patient who has the following problems: a 35-year-old white female presents with a red eye, and then she gets a bulging red eye, and then she gets double vision, and then she gets loss of vision. It's easy to get distracted by that long laundry list of complaints. However, the most common cause of acute unilateral or bilateral proptosis and adults it's actually thyroid eye disease, and so if we can make the red eye horizontal muscle injection, if we can make the proptosis from extracting a muscle margin, if we can make the double vision her motility deficit, if we can make the loss of vision from an optic neuropathy (a compressive optic neuropathy), then we'll have a single unifying diagnosis that will explain all of this patients symptoms and signs. So, instead of just having a laundry list of symptoms or complaints or problems- red eye, bulgy eye, double vision, loss of vision, optic neuropathy- we would try and look at the case and make a single unifying diagnosis. And in that person's case, we try to make it in the orbit, causing compression, causing diplopia and a red eye, and that means linking the things together with the Razor. And so, Occam's Razor would dictate that thyroid ophthalmopathy would be a better single unifying diagnosis for that constellation or sequence of problems. And then we do the same thing with the HPI and we do the same thing with the focus stem in the chief complaint. So, if you haven't watched those videos, you should as well. So, we need to go from a chief complaint, to an HPI, to a focused stem, to a single unifying diagnosis or mechanism. And the razor means having a simple explanation is best and a single explanation. But some patients have multiple problems, and so that's Hiccum's Dictum, which is the opposite of Occam's Razor: a patient can have as many diseases as they pleases.
But in general, you prefer the Razor to Hiccum's Dictum. Spencer S.There comes a point in everyone’s life when you have to make a big decision: do I stay or do I go? It could be a job, a relationship, a country, but the decision is big because you know if you decide to go, the consequences are going to be significant.įor further information regarding the rights to this collection, please visit: Eccles Health Sciences Library, University of UtahĬopyright 2019. In January 2015 I made the decision to leave NHS Nene Clinical Commissioning Group. I had worked there for seven and a half years, and I wanted to do something different. But I didn’t just leave the CCG, I left the NHS. I had reached the point where I honestly believed (and still do) that the NHS system has become such that making significant change from within it is virtually impossible.
The day to day financial and operational challenges relegate focussing on transformational change to a mere afterthought.ĭelivering transformational change requires real focus, freedom from distractions, and the ability to do things differently. For me that opportunity sits in the creation of a new organisation, one that works with the NHS, but is not part of it: Ockham Healthcare. Ockham was incorporated on the 27 th March 2015, and is part think tank, part consultancy.
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