In Medical school, there are two years learning in classrooms followed by two years of learning in practice settings (hospitals, clinics, doctors' offices). One thing you learn once you begin your "clinical" training is that there is an oral tradition --- a verbal store of lore in medical training passed on from interns and residents to students. These are usually rules of thumb (more formally, "heuristics") that help you become a better doctor. Most of them are good for all members of the health profession. I thought I would share a few with you.

Dr. Loeb was an internist from earlier in this century, and the co-author of the prestigious Cecil and Loeb textbook of medicine. These "laws" are ascribed to him. Since they are apocryphal at best, it doesn't matter if he really was their author; but they are great "laws".

1. First of all, do no harm.
2. If what you are doing works, keep doing it.
3. If what you are doing doesn't work, quit doing it.
4. (He considered this to be a corollary of his first law) Above all, never let your patient fall into the hands of a surgeon (Remember that Dr. Loeb was an internist)(It's supposed to be funny; be sure to laugh).
   

It is alleged that one night a professor of medicine at Harvard was awakened by the sound of hoofbeats. He immediately cried, "Aha! A zebra!" This rule decries the tendency we used to see for professors of medicine to focus on unlikely possibilities in finding a diagnosis for a patient's ills.

Sound a tad gruesome? All it says is that when I was in training, since we didn't know exactly what steroids did (and they do a lot), docs at medical centers were giving everyone in hopeless situations a dollop of steroids, just in case. In fact, before we had "science" in our medical bag, doctors always used the "let's try this" method; which is, of course how our forebears learned what medicines worked on what diseases. And ponder this frightening fact: it wasn't until 1994 that we learned just how aspirin works.

This is an old rule that celebrated the fact that many or most of the older meds depended a lot on the placebo effect for their efficacy. This stayed true even after the advent of double-blind controlled studies. A more grim interpretation has been showing up lately as bacteria and viruses have developed resistances to antimicrobials.

From Magnum Force. For inpatient work, this means knowing when to call a specialist. For outpatient work, this means first of all knowing that you have limitations.

Even though administrators, academicians and third party payors talk of depleting the medical commons, the patient comes first. Especially, the patient comes before your own convenience.

They will tell you what is wrong with them

But remember: patients lie (Fig Newton's law) --- or at least, give you information from their perspective, which may not seem "factual" from your perspective. So don't forget to talk to other people, too (but remember that families 'lie', too).

Even if the patient is a "crock", and you are sure there is nothing wrong --- just imaginary problems --- do a thorough examination and appropriate workup: you are a professional, and you are paid to do examinations; do what you are paid to do (Chasanow's Challenge). And even if you have examined this patient many times before, this time, the patient just may have a real problem. After all, hypochondriacs have a somewhat longer lifespan than the rest of the population, perhaps because they get earlier attention to their real problems.

Always have faith in your patient's ability to get well: every one of them has that ability, or your patient would not be coming to see you in the first place. Even involuntary patients have the capacity for change. If you have faith in your patients, they are more likely to get well. If you lose hope, it's your own countertransference talking.

If everyone was chased around the block every morning by a wild animal, there'd be very little mental illness.

There is a lot that is blamed on craziness that is due to stupidity.

These are just sayings I like:

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