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By Staff Reporters

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A medical zebra is rare a disease, one that is so rare that most doctors have not encountered a patient with that disease. Having only read about the disease in a textbook or in the case of many recently defined diseases, not at all. It is therefore difficult for medical doctors to diagnose these individuals.

The term originates from a popular saying among clinicians, “when you hear hoof-beats, think horses, not zebras”, meaning that when diagnosing a patient, one should first exclude the most common causes for a patients symptoms, before looking for rare causes. While this is a good idea in everyday practice, one must not forget to make the effort to go “zebra hunting” when the common causes don’t explain the full clinical picture. This is especially important with the current growth of genetics and personalized medicine.

Examples:

• Sutton’s law – perform first the diagnostic test expected to be most useful
• Occam’s razor – select from among competing hypotheses the one that makes the fewest new assumptions
• Leonard’s law of physical findings – it is obvious or it is not there
• Hickam’s dictum – “Patients can have as many diseases as they damn well please”
• Zebra print ribbon – awareness ribbon for rare diseases
• Samuel Gee – author of Medical lectures and aphorisms (1902)
• James Alexander Lindsay – author of Medical axioms, aphorisms, and clinical memoranda (1924)
• Maimonides – Commentary on the aphorisms of Hippocrates and Medical aphorisms of Moses (12th century)
• Sagan standard – Extraordinary claims require extraordinary evidence
• Twyman’s law – Any figure that looks interesting, or different, is usually wrong.

Now, a medical aphorisms is a pithy statement denoting a general truth. They have a special niche in medical discourse and writing. The use of aphorisms in medicine dates to ancient times and continues today.

EDUCATION: Books

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