In medicine, a "zebra" is a rare and unusual cause for a common symptom. Occam's razor or the Principle of Parsimony and Principle of Simplicity (the simpler the explanation, the better) tell us to look for obvious reasons for a symptom, "all things being equal," by "shaving off" theories filled with the most assumptions and focus on theories with the least number of hypothetical entities. In other words, "when you hear hoof-beats, think horses, not zebras." It also tells us not to multiply hypotheses unnecessarily.
Horses, zebras, giraffes, oh my...
Einstein summed up the importance in avoiding over-simplification of the above: "Everything should be made as simple as possible, but not simpler." Einstein is telling us not to miss the giraffes or anything else that might mimic a horse, or zebra. In terms of comprehensive medicine, a master diagnostician or a master of the differential diagnosis should therefore be sharper than the zebra hunter. The phrase is also telling us not to treat every headache as an aspirin deficiency, or every chest pain relieved by nitroglycerin for the first time as only a nitroglycerin deficiency. (thanks, Albert).
In modern medicine, the entity which fits Occam's razor the best is a pharmaceutical, which is the simplest solution in alleviating a symptom. For example, if someone has a headache, then the simplest solution is a pharmaceutical such as aspirin. If they're depressed, then the quickest and easiest solution to the problem is a psychotropic agent such as prozac. In the clinical setting, the physician, who routinely does not have the luxury of time, easily resorts to the "prescriptus interruptus," and gives it to the patient. The patient then conveniently heads for the pharmacy, who keeps the physician's solution on their shelves. Many pharmaceuticals are band-aids, with obvious exceptions given to antibiotics and other pharmaceuticals which provide cure of both the illness and the symptom. Pharmaceutical "band-aids" are also helpful when the cause is not instantly ascertained. Kind of like sticking one's finger in a dyke until the proper masonry can be accomplished, or tying a rope on a hanging muffler until one gets to the repair shop. The problem lies in using pharmaceuticals to suppress or hide a symptom, and making this the end-point of Occam's razor, i.e., allowing the illness or cause to continue its existence.
Therefore, not every depression should be viewed as a prozac deficiency. Asthma should not be viewed as an albuterol deficiency. Headache might progress to serious consequences if viewed only as an aspirin deficiency. The essay on my HMO experience Beyond Conventional Medicine touches on this theme: I defied my gatekeeper and sent my patient with chest pain to the hospital, despite his insistance that the patient was only suffering from a nitroglycerin deficiency, and should be sent home with the same, but would not provide such a statement in writing. If I had listened to my gatekeeper, I could have made my patient pay with his life.
"The more you learn, the more you grow, and see there's so much more to know." - TJB
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The essays include my formal (and informal) education, "magic moments," and opinions on healthcare and politics. Magic Moments are those episodes which enhance life with enlightenment and wisdom. They are the spiritual learning experiences which re-shape our souls, and change the way we perceive the world, ourselves, and others. Such moments are often associated with a smile both at the time of occurrence and each reflection thereafter, and hopefully, when they are shared with others.
Thomas Bolte, MD runs an comprehensive integrated medical clinic and urgent care center in midtown Manhattan, and makes physician house call visits to midtown nyc residents and hotel guests. More info on Doctor Bolte on his personal webpage and New York Urgent Care website.