Zebras

When I was a student in chiropractic school, we were taught to be efficient but thorough. We were taught to perform our physical examinations of the patient ordering the fewest exams and the least costly. The purpose for the exams was to confirm what we suspected to be the problem, and were not to be used in an exploratory fashion hoping the exam would diagnose for us. We were taught that exam findings should never surprise us and that we should look for the obvious. In case the obvious eluded us, then we were to dig deeper and bring out the, "big guns". Occasionally there would be some students that would perform every exam procedure in the book, and order the biggest lab studies for patients that had simple problems. We used to say that these students were looking for, "Zebras". Diagnostic over kill. I run into the same problem in daily practice, only from the patients side of things. Too many patients are demanding, "the big guns", for simple things from muscle strains and joint sprains to headaches and low back pain. There is no need for x-ray, MRI, Nerve conduction studies and the like when the problem is simple and has a simple fix. Sometimes I think patients like the big diagnosis, it gives them a sense of grandure, purpose and maybe of legitimacy where their spouse is concerned. Most of what I see in practice requires a hand full of visits with some deep tissue massage, chiropractic manipulation and ultrasound, and patients do just fine. There are some patients who don't have a big problem, only slow healing times, and this prompts them to seek bigger treatments that in the end did not serve them. All the patient needs is simply more patience...