Missing a 'Zebra': See What Physicians Say

Sandra Levy


August 22, 2018

In This Article

The Search for Zebras

Among physicians who believe that looking for the zebras is wise, a pediatrician said, "In my practice I was criticized for always looking for zebras. As if that type of thought process was defective. I was shamed for it. I can tell you that I tended to zebras. After my own chronic health issues, I think that zebras are way more common than anyone realizes, that many illnesses considered rare are not rare at all, just missed by all the docs who are looking for horses."

Medical training should encourage physicians to look for zebras, remarked a surgeon. "Looking back on a long surgery career, it was not that unusual to come across a rare condition because there are a lot of them out there. I am sure the same thing is true in a medical practice. Part of good training is to recognize that you are not looking at a horse and start thinking of the zebras."

Physicians often criticize electronic medical records (EMRs) for creating extra work, but one physician finds them helpful when diagnosing patients. "I'm sure my partners agree. We were just discussing this a few months ago when the prospect of switching EMR systems came up."

"We were talking about times when the system has helped remind us to access some tidbit we otherwise have filed away deep in our brains—the type of knowledge to help remember the zebras when it's not horses galloping down the road," he continued. "Our EMR is far from perfect but it has been helpful in some cases like this."

Finally, another physician thinks outside the box when making a diagnosis. "I think it's not about ruling out all the possible zebras on every case as much as it is about making sure your striped animal is really a horse. I've seen several cases of misdiagnosis where the primary on the case simply labeled them as 'atypical,' and told them sometimes people fail to respond to treatment. It's easy, as physicians, to forget that diagnosis of 'atypical' anything should be a diagnosis of exclusion."


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