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Created: 2025-09-17, curriculum
Medical maxims and aphorisms are concise, memorable statements that encapsulate important principles of medicine. They serve as valuable tools for teaching, clinical reasoning, and professional reflection, distilling complex ideas and accumulated wisdom into easily recalled phrases.
These maxims form the ethical and philosophical bedrock of medical practice.
First, do no harm. (Primum non nocere)
Value: This is arguably the most fundamental principle in medicine. It reminds clinicians that any intervention—be it a drug, a procedure, or even a test—carries the potential for harm (iatrogenesis). The primary consideration must always be whether the potential benefits outweigh the risks.
Origin: While widely attributed to the Hippocratic Oath, the exact phrase does not appear in it. It is believed to be a Latin distillation of a similar Hippocratic principle: "to abstain from doing harm".
Cure sometimes, treat often, comfort always.
Value: This maxim beautifully summarises the three core duties of a physician. It acknowledges the limits of medicine (curing is not always possible) but emphasises the constant responsibility to provide treatment to alleviate symptoms and, crucially, to offer comfort, empathy, and support to every patient, regardless of the outcome.
Origin: The phrase is often attributed to the 15th-century French surgeon Ambroise Paré, whose personal motto was a similar phrase in French. It was popularised in the English-speaking world by Dr Edward Trudeau, who had it inscribed over the entrance to his sanatorium.
Ars longa, vita brevis. (The art is long, life is short.)
Value: This highlights the vastness of medical knowledge and the lifelong commitment required to master it. It serves as a reminder of humility; a physician's education is never complete, and there is always more to learn in a limited lifetime.
Origin: This is the opening line of the Aphorisms of Hippocrates, the ancient Greek physician considered the father of Western medicine.
The secret of patient care is caring for the patient.
Value: This statement cuts through the technical and scientific aspects of medicine to its humanistic core. It asserts that empathy, compassion, and a genuine interest in the patient as a person are essential for effective care, not just technical proficiency.
Origin: Attributed to Francis W. Peabody, a physician at Harvard Medical School, from a 1927 lecture to students.
These maxims guide the process of clinical reasoning and arriving at a diagnosis.
When you hear hoofbeats, think of horses, not zebras.
Value: This is a core principle of differential diagnosis. It advises clinicians to first consider the most common and probable causes of a patient's symptoms ('horses') before investigating rare and exotic diseases ('zebras'). It promotes efficiency and avoids unnecessary and costly testing.
Origin: Credited to Dr Theodore Woodward at the University of Maryland School of Medicine in the late 1940s.
Common things are common.
Value: A simpler, more direct version of the 'hoofbeats' maxim. It is a powerful reminder to not overcomplicate a diagnosis. Statistically, a patient is far more likely to have a common illness than a rare one.
Origin: A widely used aphorism in medical education, its specific origin is unclear but it embodies the principles taught by Sir William Osler.
If you don't think of a diagnosis, you'll never make it.
Value: This maxim stresses the importance of a broad differential diagnosis. A physician must first consider a condition as a possibility before they can perform the tests or ask the questions needed to confirm or refute it. It is the counter-balance to 'common things are common', reminding doctors to keep an open mind.
Origin: A common teaching pearl, of uncertain specific origin.
Listen to your patient; he is telling you the diagnosis.
Value: This champions the importance of taking a thorough patient history. Sir William Osler estimated that 80% of diagnoses can be made from the history alone. It reminds clinicians that the patient's narrative contains the most crucial clues.
Origin: Widely attributed to Sir William Osler (1849-1919), a foundational figure in modern medicine.
The eye cannot see what the mind does not know.
Value: This maxim underscores that clinical observation is not passive. To recognise the signs of a disease—be it a subtle skin rash, a specific gait, or an anomaly on an X-ray—the clinician must first have the knowledge that such a sign exists and what it signifies.
Origin: A long-standing medical proverb, its precise origin is unknown.
Sutton's Law: Go where the money is.
Value: In medicine, this means ordering the test or performing the procedure that is most likely to yield a definitive diagnosis. It is a principle of diagnostic efficiency, advising against a scattered, unfocused approach to investigation.
Origin: Named after the American bank robber Willie Sutton, who, when asked why he robbed banks, purportedly replied, "Because that's where the money is." The medical application was popularised by the physician and author Dr Fred Plum.
Occam's Razor: The simplest explanation is usually the best.
Value: This principle suggests that when a patient presents with multiple symptoms, it is more likely they result from a single, unifying diagnosis rather than several concurrent diseases.
Origin: Named after the 14th-century Franciscan friar William of Ockham. While not originally a medical principle, it was quickly adopted into diagnostic reasoning.
Hickam's Dictum: A patient can have as many diseases as he damn well pleases.
Value: This serves as a crucial counterpoint to Occam's Razor, particularly relevant in the modern era of chronic, multi-morbid patients. It warns against prematurely closing a diagnostic investigation once one condition is found, as other co-existing pathologies may be present.
Origin: Attributed to Dr John Hickam, a 20th-century American physician.
The physical exam begins the moment you first see the patient.
Value: This reminds clinicians that observation is key. A patient's gait as they walk into the room, their posture, their breathing, and their general demeanour can provide vital diagnostic clues even before a formal examination begins.
Origin: A common teaching point in medical schools, its origin is diffuse.
These maxims concern the practical application of medical therapies.
The dose makes the poison. (Sola dosis facit venenum)
Value: This is the foundational principle of toxicology and pharmacology. It states that any substance, even water, can be toxic at a high enough dose, while a substance considered toxic can be safe (or therapeutic) at a low enough dose. It is critical for safe prescribing.
Origin: Attributed to Paracelsus (1493-1541), a Swiss physician and alchemist.
Don't just do something, stand there!
Value: This is a vital warning against the impulse to intervene reflexively without sufficient information or a clear plan. Sometimes, the best course of action is watchful waiting and careful observation, allowing the natural course of an illness or the effects of a treatment to become clear.
Origin: Attributed to various sources, often as a piece of advice given to junior doctors in emergency situations.
A chance to cut is a chance to cure.
Value: A classic surgical maxim, it reflects the definitive, curative potential of surgery for many conditions (e.g., appendicitis, early-stage cancers). It encapsulates a proactive, interventionist surgical philosophy.
Origin: A traditional, almost folkloric, saying within the surgical community.
All bleeding stops eventually.
Value: This is a piece of gallows humour, primarily used in surgery and emergency medicine. It carries a grimly practical truth: the clinician's job is to stop the bleeding before the patient's death makes it a moot point. It underscores the urgency of controlling haemorrhage.
Origin: Another piece of surgical folklore with no single identifiable author.
The operation was a success, but the patient died.
Value: A deeply cynical maxim that highlights the danger of focusing on technical success at the expense of the overall patient outcome. A perfectly executed procedure is a failure if the patient does not benefit or survive. It warns against a narrow, procedure-focused view of medicine.
Origin: A common satirical phrase, its origin is in critiques of medical hubris.
Treat the patient, not the disease (or the monitor, or the lab value).
Value: This warns clinicians against making treatment decisions based solely on isolated data points (like a blood test result or a number on a monitor) without considering the full clinical picture and the patient's overall state.
Origin: Another principle popularised by Sir William Osler.
Let food be thy medicine and medicine be thy food.
Value: This maxim emphasises the crucial role of nutrition in health and disease prevention. It advocates for diet as a primary tool for maintaining wellbeing, a concept that is a cornerstone of public health and lifestyle medicine today.
Origin: Universally attributed to Hippocrates, though the exact quote is likely a paraphrase of his teachings.
These are more concrete, specialty-specific rules of thumb.
Time is brain.
Value: Used in neurology, this maxim stresses the extreme urgency of treating a stroke. Every minute that blood flow to the brain is blocked, millions of neurons die. It galvanises rapid diagnosis and intervention to preserve brain function.
Origin: A modern public health campaign slogan, summarising decades of stroke research.
Time is muscle.
Value: The cardiology equivalent of "Time is brain". It refers to a myocardial infarction (heart attack), where the heart muscle is deprived of oxygen. The quicker the blocked artery can be opened, the more heart muscle is saved.
Origin: Similar to "Time is brain", it is a modern distillation of clinical knowledge.
Age is not a disease.
Value: A core tenet of geriatrics. It is a reminder not to dismiss a patient's symptoms as merely "old age". Elderly patients are entitled to a full diagnostic work-up, as their complaints are often caused by treatable underlying conditions, not age itself.
Origin: A common refrain in geriatric medicine, of diffuse origin.
Unexplained anaemia in an older man is colorectal cancer until proven otherwise.
Value: This is a classic "red flag" maxim. It forces the clinician to rule out the most serious potential cause of a common finding. Chronic, slow bleeding from a colon tumour is a very common cause of iron-deficiency anaemia in this demographic.
Origin: A well-established clinical pearl taught in gastroenterology and general medicine.
The most important test is the test of time.
Value: For ambiguous or non-urgent symptoms, observing the patient over a period can be the most effective diagnostic tool. The evolution of symptoms—whether they worsen, improve, or change character—often reveals the true nature of the underlying problem.
Origin: An old medical proverb, reflecting the wisdom of patience in diagnosis.
These maxims relate to the culture of medical training and daily professional life.
See one, do one, teach one.
Value: The traditional model for teaching procedural skills in medicine, especially surgery. A trainee first observes a procedure, then performs it under supervision, and finally solidifies their knowledge by teaching it to someone else.
Origin: Attributed to Dr William Stewart Halsted, one of the founding professors of Johns Hopkins Hospital.
If it's wet and not yours, wear gloves.
Value: A blunt but effective summary of universal precautions. It advises healthcare workers to treat all bodily fluids as potentially infectious, forming the basis of modern infection control.
Origin: Emerged during the HIV/AIDS crisis in the 1980s as a key public health message.
The cemetery is full of indispensable men.
Value: A reminder to doctors, who often work long hours under immense pressure, about the importance of their own wellbeing and work-life balance. It warns against self-sacrifice to the point of burnout, stressing that no one is truly irreplaceable.
Origin: A general aphorism (often attributed to Charles de Gaulle), but one that resonates deeply within the medical community.
The days are long, but the years are short.
Value: Often used to describe medical training (and parenthood). It captures the feeling of gruelling, endless days during residency or specialty training, which in retrospect seem to pass in a flash. It speaks to the intensity and transformative nature of the process.
Origin: A common modern saying, popularised by author Gretchen Rubin but widely adopted in medicine.
Trust, but verify.
Value: While not exclusively medical, this maxim is critical in clinical practice. A clinician should trust the information provided by the patient, previous doctors, and test results, but always maintain a healthy scepticism and verify critical information for themselves. This prevents the propagation of errors.
Origin: A Russian proverb popularised in English by US President Ronald Reagan during the Cold War, it has been widely adopted in fields where verification is critical.