Robert Frederick Loeb (March 14, 1895-October 21, 1973) was a famous American Physician who provided some very simple common sense approach to treating patients know as:
Loeb’s Rules of Therapeutics or Loeb’s Laws of Medicine
1. If what you are doing is doing good, Keep doing it.
2. If what you are doing is not doing good, Stop doing it.
3. If you do not know what to do, Do nothing.
4. Never make the treatment worse than the disease.
The last ‘law’ in present times is often replaced with:
If at all possible, keep your patient out of the operating room.”
Or
Above all, never let a surgeon get your patient.
His timeless wisdom and common sense approach is still applicable in present time.
His rule No. 1: If what you are doing is doing good, keep doing it, appears simple but is highly appropriate in many situations.
Newer drugs are being discovered and presented as the next panacea by the pharmaceuticals companies. In an attempt to keep up with the latest development in their field, many doctors switch to newer options, even when the older options doing their job well. So do not change to newer drugs or technology if the older ones are working well. If an older generation antibiotic is controlling the infection, then there is no need to change to a newer drug. If an older drug is controlling the blood pressure well then don’t replace it with any newer drug just for the sake of novelty.
Another common decision is when to change or stop a drug. In many infectious conditions, the antibiotics are recommended for 5 to 14 days. So, some physicians change the antibiotics after 5 days, even if the patient is showing good clinical response. If you follow Rule No. 1, you will change the antibiotics only when they stop giving clinical response. This will avoid frequent antibiotics changes and will help in prevention of emergence of antibiotic resistant strains of bacteria.
His Rule No. 2. If what you are doing is not doing good, stop doing it, has got great clinical relevance. Each patient is different and there may be variation in the clinical response of the patient depending on many factors including genetic variations and idiosyncrasies. So even if treatment option or drug is highly recommended, but if the patient is not getting benefitted by it, stop it and consider some other option.
His rule No.3: If you do not know what to do, do nothing, requires great courage to apply. Faced with such situation it is better to consult some seniors or keep the patient under close observation, till you are clear on the path to take. I remember from MBBS days, the phrase ‘masterly inactivity’ used many times while discussing management of many conditions in Dutta’s Obstetrics textbook.
4. Never make the treatment worse than the disease. Again the doctor when faced with some situation, feel that just because the patient has come to him that some form of treatment should be given to the patient. Sometime patient may experience side-effects of drugs which may be worse than their original illness. Patients in the terminal (last) stage of cancer may spend the last part of their life in misery due to the side-effects of the drugs given to prolong their life. Their survival time may get extended but the number of disease free or happy days of life left may get reduced.
The last ‘law’ in present times is often replaced with: “If at all possible, keep your patient out of the operating room.” Or Above all, “never let a surgeon get your patient” may be due to over enthusiasm of some surgeons and may reflect the poor outcome after surgery during Dr. Loeb’s time period. Surgical techniques, care and outcome have vastly improved, and when indicated the physicians should himself refer the patient to surgeons.
But truly a valid point has been raised, as for surgical over enthusiasm, there can be no cure. For e.g. young ladies sometimes come to surgeons with a small breast lump, which may be left alone and kept under observation. If operated and the lump is removed, the patient may be left with an unsightly scar and an area of residual hardness (induration) at the site of the lump, which may be worse than the original lump. Surgeons should be judicious in their decision in advising surgery in individual patients.
Our teacher, the great surgeon, Professor Tushar Kanti Chattopadhyay ( Prof. T. K. Chaterjee), used to say, 'It takes 3 years for a person to learn how to operate. But it takes a lifetime to learn when not to operate.'
Some of Dr. Loeb's other famous aphorisms are:
"There is no such thing as a dull patient, only a dull physician".
"The Bible says 'seek and ye shall find'; seek not and you won't find a damn thing."
"Remember the Golden Rule: Do unto others as you would have done to you if you were that patient in that bed at that time".
— ND
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Read also about Merskey's Rules: http://agnipathdoctors.blogspot.com/2016/04/merskeys-rules.html
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DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost.
DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Education should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost and according to MCI and other Board’s norm.
