Funtabulously Frivolous Friday Five 091

• Socrates… It seems that some things never change, eh.
• The quotation was attributed to Socrates by Plato, according to William L. Patty and Louise S. Johnson, Personality and Adjustment, p. 277 (1953).
• Unfortunately, the attribution of this quotation is probably spurious.
• Astute, longtime readers of LITFL may rember this quote featuring in Lessons from Osler 001 — The Master Word.

—

• Blood and bandages (there are plenty of other explanations but I like this one best!).
• Prior to 1800 and the formation of the Royal College of Surgeons most surgeons were members of the Royal College of Barbers and Surgeons and had no formal medical qualifications. In other words, the chap who cut your hair and shaved your beard would also chop your leg off if so desired.
• In remembrance of these origins surgeons in the UK and the former colonies often still use the exclusive designation “Mister” rather than “Doctor”.
• According to Wikipedia:

“The original pole had a brass wash basin at the top (representing the vessel in which leeches were kept) and bottom (representing the basin that received the blood). The pole itself represents the staff that the patient gripped during the procedure to encourage blood flow.”

• Learn more at Wonders & Marvels — A History of the Barber’s Pole.

—

•  A type of cognitive bias coined by Pat Croskerry that occurs when a rare diagnosis (zebra) figures prominently on the differential diagnosis but the physician fails to pursue it.
• This can occur for any one, or a combination, of the reasons below:

1. perceived inertia in the system and barriers to obtaining special or costly tests
2. self-consciousness and underconfidence about entertaining remote and unusual diagnosis and gaining a reputation for being esoteric
3. the fear of being seen as unrealistic and wasteful of resources
4. under- or overestimating the base-rate for the diagnosis
5. the ED might be very busy and the anticipated time and effort to pursue the diagnosis might dilute the physician’s conviction
6. team members might exert coercive pressure to avoid wasting the team’s time
7. inconvenience of the time of day or weekend and difficulty gaining access to specialists
8. unfamiliarity with the diagnosis might make the physician less likely to go down an unfamiliar road
9. and fatigue or other distractions might tip the physician toward retreat.

• This explanation of ‘zebra retreat’ is excerpted from this must read textbook:

Crosskerry P, Cosby KS, Schenkel SM, Wears RL. Patient Safety in Emergency Medicine. Lippincott Williams & Wilkins, 2009. [Google books preview]

—

• The legendary John Hunter
• Hunter had a fascinating collection of animals and oddities, hence the purported inspiration for Hugh Lofting’s Dr John Doolittle.
• His brilliance and mixed reputation for walking the fine line of ethical practice (he employed grave robbers for instance) is believed to have inspired Robert Louis Steven’s Strange Case of Dr Jekyll and Mr Hyde.

—

• The legendary John Hunter… again.
• Among a myriad of other amazing discoveries, Hunter also who proved the contagiousness of venereal disease by self-inoculation (if you believe the legend) though he thought he’d shown that gonorrhea and syphilis were manifestations of the same disease, not realising that STIs have a tendency to hunt in packs…

Do you know John Hunter? Every doctor should…

—