Sometimes Those Hoofbeats Are Zebras: A Narrative Analysis

Abstract

The case of BB, an 11-year-old girl who was hospitalized because of sudden odd seizure-like symptoms and catatonic affect, highlights several ethical issues and communication problems. The correct diagnosis was initially missed, partly because physicians are trained to think of the most common explanation for a patient's symptoms; the medical education truism "when you hear hoofbeats, think horses, not zebras" was not helpful in BB's case. The common habit of medical professionals to not revisit a diagnosis once one is established also led to missed opportunities to provide appropriate care for this young patient. The difficulty nurses and/or family members have in questioning a diagnosis and treatment plan are also discussed.

Beyond Competence: Efficiency in American Biomedicine

“…For instance, if they failed to learn about a rare disease, side effect, or presentation, might they fail to recognize these conditions in patients? Certainly, rare disease advocates and scholars have criticized the common push in medical education for students to "think horses" (the common condition) not "zebras" (the rare condition) which may lead to overlooking rare conditions (Roscoe 2017), though the maxim entails keeping zebras in mind while dismissing them (Hunter 1996). Scholars therefore advocate for rare disease education in medical school, while recognizing the impossibility of teaching every detail about every disease, and focusing instead on more common rare diseases and on general trends in patient experiences (Cismondi et al 2015;Groft et al 2019).…”