“When the Answer is Too Obvious to See”

Today, I want to talk about a common misconception people have when trying to find the reason behind a problem. This happens in medicine, just like in many everyday situations.

Let’s start with medicine.

Many people think medicine is like House M.D., but — spoiler alert — 99% of the time, it’s not. Okay, I don’t have the exact percentage, but you get the point.

Some people, especially those who are a bit hypochondriac or very sensitive to their bodily sensations, tend to assume the worst-case scenario whenever they feel something off. And the internet doesn’t help. You have a minor symptom, look it up, and suddenly you’re convinced you have a rare, fatal disease. More often than not, these fears stem from personal or secondhand experiences rather than an actual medical issue.

Now, I’m not saying rare diseases don’t exist or that we should ignore them. But most of the time, the correct answer is the most obvious one — so obvious we often overlook it.

Let me give you a real case example: I had a patient with abnormally high blood levels of chloride and sodium. There were many possible reasons for this. To give you some context, she had been diagnosed with sarcoidosis 20 years ago and claimed to be in remission. However, her lab results also showed very high calcium levels, acute kidney failure, and persistent nausea and vomiting.

I assumed her electrolyte imbalance was either causing or being caused by her vomiting and kidney failure. But after a while, I realized I wasn’t making any progress in figuring it out.

That’s when my supervisor walked by and asked, “Doctor, how’s the patient doing?” I started explaining all my findings, listing every possible differential diagnosis I had researched — because, let’s be honest, I spent quite some time digging deep into the connection between sarcoidosis and electrolyte imbalances.

My supervisor listened patiently, then, with a look that said, “Are you done?”, simply said: “Make sure she’s not getting too much sodium chloride in her IV fluids.”

For those who don’t know, many IV medications are mixed with solutions that contain significant amounts of sodium and chloride. Since my patient had been receiving a lot of fluids due to her nausea, vomiting, and kidney issues… yep, you guessed it — one of them contained a lot of sodium chloride.

I had completely overlooked this. Once we switched her IV fluids to a lower-sodium option, her lab values quickly normalized.

To my surprise (not really), I had overanalyzed the case, while my experienced supervisor immediately recognized this common hospital phenomenon.

Another example of this is the people who take creatine supplements. When you consume creatine, it breaks down into creatinine, which can temporarily elevate blood creatinine levels. This sometimes leads doctors to suspect kidney disease when, in reality, it’s just a harmless side effect of supplementation.

And this bias towards overcomplicating things happens outside of medicine, too.

A few months ago, we had a heating problem in our apartment. The upstairs temperature was ridiculously high, but adjusting the thermostat only worked sometimes. Days passed, and we couldn’t figure it out — until we got the electricity bill.

It was sky-high, so we finally called a heating technician.

He took one look at the heating system’s display, smiled, and asked, “What time is it?”

We answered, “Uh, 8 PM?”

Still smiling, he said, “No, I mean, what time is it really?”

My partner and I exchanged confused glances.

The technician then explained that our thermostat operates on a schedule: at night, it lowers the temperature to save energy, then starts warming up again in the early morning. Since there had been power outages due to construction nearby, the thermostat’s internal clock had reset. It thought it was 4 AM when it was actually 8 PM, so it wasn’t heating the apartment properly.

And just like that, he fixed it by resetting the clock.

We had looked at that thermostat display dozens of times but never noticed the wrong time. Instead, we assumed there was a major issue with the pipes or that the construction work nearby had somehow affected our system.

We completely ignored the most obvious answer.

So next time you’re faced with a problem and don’t know where to start, think about Ockham’s Razor.

Ockham’s Razor (or the principle of parsimony) is a philosophical idea from the 14th-century friar William of Ockham. It states that when there are multiple possible explanations for something, the best one is usually the simplest — meaning it requires the fewest assumptions. This doesn’t mean the simplest answer is always correct, but it’s usually a good starting point before jumping to complex conclusions.

Or, as we were taught in med school: “If it has an elephant’s head, an elephant’s tail, and an elephant’s feet… what do you think it is?”

…

“Ah… a pink elephant ?” 😉