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Evidence of Things Not Seen: The Match, Vienna & Unknown Unknowns

Philip Seo, MD, MHS  |  Issue: August 2022  |  August 13, 2022

This will not be true forever. But because our patients can’t wait for perfect diagnostic tests, the diagnosis of exclusion remains a useful concept. It reminds us all to think nimbly about our patients, to have faith in our clinical acumen and—most importantly—to remain open to evidence of things not seen.


Dr. Seo

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Philip Seo, MD, MHS, is an associate professor of medicine at the Johns Hopkins University School of Medicine, Baltimore. He is director of both the Johns Hopkins Vasculitis Center and the Johns Hopkins Rheumatology Fellowship Program.

References

  1. Roth AE. The origins, history, and design of the resident match. JAMA. 2003 Feb 19;289(7):909–912.
  2. AAMC History. https://www.aamc.org/who-we-are/aamc-history.
  3. Doyle AC. The Sign of the Four. The Project Gutenberg eBook [ebook 2097]. Release date: March 2000.
  4. Editors. University of Vienna. Encyclopaedia Britannica. https://www.britannica.com/topic/University-of-Vienna.
  5. ‘And there’s the humor of it.’ Shakespeare and the four humors. National Library of Medicine. https://www.nlm.nih.gov/exhibition/shakespeare-and-the-four-humors/index.html.
  6. Rothemich K. Chapter 4. Galen’s Anatomical anomalies and discoveries. In Science, Technology, & Society: A Student-Led Exploration. Clemson University. (CC BY-NC 4.0) https://opentextbooks.clemson.edu/anne1/chapter/ancient-anatomy-galen-2.
  7. Glorious peaks and painful depths—Viennese medicine. Medical University of Vienna. https://tinyurl.com/f9xw8tuy.
  8. Obituary. Professor Josef Skoda. Edinburgh Medical Journal. 1881;27(part1):286–287. https://tinyurl.com/rsfuuemy.
  9. Semmelweis IF. The Etiology, Concept, and Prophylaxis of Childbed Fever. 1859. Translated by Carter KC. Madison, Wis.: University of Wisconsin Press; 1983. https://archive.org/details/etiologyconcepta0000unse.
  10. Pasteur L, Ernst HC. [On the extension of the germ theory to the etiology of certain common diseases]. Comptes Rendus de l’Académie des Sciences. 1880 May;XC:1033–1044.
  11. Putman M, Patel JJ, Dua A. There is no diagnosis of exclusion in rheumatology. Rheumatology. 2022 May 12.
  12. Houghton M. Discovery of the hepatitis C virus. Liver Int. 2009 Jan;29(Suppl 1):82–88.
  13. DoD news briefing. Secretary Rumsfeld and Gen. Myers. U.S. Department of Defense archive. 2002 Feb 12. https://archive.ph/20180320091111/http://archive.defense.gov/Transcripts/Transcript.aspx?TranscriptID=2636.

Author’s note: I would like to thank Anisha B. Dua, MD, MPH, for graciously allowing me to comment on her editorial, which you should definitely read for yourself.11

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Filed under:OpinionRheuminationsSpeak Out Rheum Tagged with:DiagnosisexclusionMatchresidency

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