Loeb’s laws of medicine: they still apply

I’ve written about this before, but it’s always a good thing to remind ourselves of simple things in medicine. The severe-looking physician pictured above is Robert F. Loeb, long a professor at Columbia University Medical School. He reportedly could be a bit tyrannical to students and residents, but he is credited with formulating a simple way to cut through to the nub of things.

Sometimes we doctors are prone to do too much to our patients, especially in high-tech environments like the PICU. The bewildering array of all the tests and therapies we have can confuse us more than enlighten us. Dr. Loeb long ago offered a simple way to cut through all the confusion, offering what have come to be known as Loeb’s Laws. We all learned variants of them in medical school, but now and then we need to be reminded of them. Here is one formulation:

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.

Dr. Loeb was not a surgeon, so one occasionally hears a tongue-in-cheek substitution of his fourth law that goes something like this: “If at all possible, keep your patient out of the operating room.”

Seventy years later, Dr. Loeb’s wisdom is still often useful. All of us, doctors and patients, are tempted to do things just because we can do them, or because we’re curious. That’s never a good way to proceed.


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