Occam's Razor
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Occam's RazorWilliam E. Morgan, D.C.
William of Ockham (Occam) was an English
philosopher and logician who lived from 1285 -1349.
He is remembered for his views on minimalism, most
notably Occam’s Razor:
“It is needless to do more when less will
suffice.”
This maxim is frequently quoted in philosophical discussions on
healing. In its essence
it reminds providers that just because you can do more to a
patient, does not mean that you should do more. Consider this
illustration comparing complex and minimal interventions:
Who would be more essential to a patient’s care: a
skilled neurosurgeon who is able to perform an intricate spinal
surgery to spare a patient infirmity or a technician who was
able to teach that patient the spinal mechanics needed to
prevent surgery?
We can agree that both practitioners may be valuable at
different stages in the patient’s care.
However, the technician could conceivably prevent the
need for the highly trained surgeon.
By that standard the technician would be more valuable.
This illustration can work equally as well with
other specialties: Would
a nutritionist who educates patients in how to prevent heart
disease or diabetes be more important than the expensive
specialists who would later try to minimize the effects of these
diseases? Of course
simple preventive measures are substantially more effective than
complex treatment.
Occam's Razor in
Integration
There is a lack of
strong evidence on what works best for most spinal conditions.
So in the absence of clear treatment superiority, we
should employ the simplest and safest treatments first.
If conservative care fails, then transition to more
complicated and risky treatments such as spinal injections,
medications, and surgery.
The Annals of
Internal Medicine recently published a set of
guidelines for managing low back pain.*
These guidelines incorporate the promotion of an active
lifestyle, training patients in self-care, interdisciplinary
rehabilitation, exercise, spinal manipulation, and behavior
training. These are
all modalities that fall within the scope of chiropractic
practice. The
guidelines also recommend acupuncture, over-the-counter
analgesics, yoga, and progressive relaxation.
More complicated interventions were not included in the
early treatment of back pain. These
guidelines clearly follow Occam’s Razor, and
chiropractors are clearly able to provide most
of guideline’s recommendations.
Complex
Conditions
While a useful tool, it is dangerous to apply
Occam’s Razor too liberally. There are many
conditions that are complicated and need
dramatic and complicated treatments. For
example: a conus medularus syndrome is a medical
emergency and may require an invasive surgical
solution.
H.L. Mencken provided us with a cheeky retort to
over simplification: "For every complex
problem, there is an answer that is clear,
simple—and wrong."
Some conditions are complicated and need to be
referred to interventional specialties.
Complex problems may require a complex
solution, but it is preferred to start with less
invasive treatments before proceeding to more
invasive interventions. Having a trusted team of specialists allows the patient to have
continuity of care. The patient begins with the
non-invasive treatment of a chiropractor and, if
necessary, concludes with an interventional
specialty.
In forming a team of diverse specialists,
promote yourself as the conservative
non-pharmaceutical, non-surgical specialist of
the team.
There is a brief time when most health
conditions are large enough to be recognized,
yet small enough to be resolved with a simple
intercession.
If untreated, they will progress into
conditions that cannot be healed.
It is our calling to be the providers who
recognize conditions when they are small enough
to be corrected.
*Chou
R et al. Diagnosis and treatment of low back
pain: A joint clinical practice guideline from
the American College of Physicians and the
American Pain Society. Ann Intern Med
2007 Oct 2; 147:478.
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