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Of Hoofbeats, Horses, and Zebras: A "Conversation" with Drs. William Dock, Theodore Woodward, and Alvan Feinstein.

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Sutton's Law: A Lesson in Decision-Analysis from the Past…and Present.

David A Nardone1

  • 1School of Medicine, Oregon Health & Science University, Portland, OR, USA. danardone@icloud.com.

Journal of General Internal Medicine
|October 21, 2024
PubMed
Summary

Sutton's Law, initially emphasizing specific tissue biopsy for diagnosis, has evolved. The modern interpretation, rooted in formal medical decision-analysis, prioritizes comprehensive patient assessment and judicious test selection for accurate diagnosis and management.

Keywords:
Sutton’s Lawaphorismsclinical problem-solvingformal medical decision-analysismaxims

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Area of Science:

  • Medical Diagnostics
  • Clinical Decision-Making
  • History of Medicine

Background:

  • Sutton's Law, coined in 1960, advocated for direct diagnostic tests, like biopsy, for definitive answers.
  • Its origin is linked to Dr. William Dock's recommendation for a liver biopsy in a young girl, referencing Willie Sutton's rationale for bank robbery.

Purpose of the Study:

  • To trace the evolution of Sutton's Law from its origins to its modern interpretation in clinical practice.
  • To highlight the shift from prioritizing specificity in tissue diagnosis to a broader approach in medical decision-analysis.

Main Methods:

  • Historical analysis of medical aphorisms and their influence on diagnostic practices.
  • Examination of the development of formal medical decision-analysis (FMDA) and its integration into clinical workflows.
  • Review of the conceptual underpinnings of Sutton's Law and its adaptation over time.

Main Results:

  • Sutton's Law initially championed specificity, particularly through tissue biopsy, for diagnostic certainty.
  • Formal medical decision-analysis (FMDA) emerged as a standard, incorporating a wider range of diagnostic considerations.
  • The contemporary understanding of Sutton's Law emphasizes a holistic approach, prioritizing patient history, physical examination, and targeted laboratory tests.

Conclusions:

  • Sutton's Law, though sometimes viewed as obsolete, offers enduring lessons in clinical decision-making.
  • Its evolution reflects the advancement of medical science and diagnostic methodologies.
  • The principle of judiciously selecting diagnostic evaluations remains critical for effective patient care.