The MythBusters television show uses sound scientific methods to figure out complex mysteries. I found out early on my veterinary classmates were inordinately intelligent. Give them a list of multi-host parasite lifecycles to memorize; next thing you know, you are in a study group playing a modified form of Monopoly (“Parasitopoly” to be exact) to make the all-nighter cram session stick in your brain better. Teach hundreds of pharmacology facts, and soon you see someone’s color-coded, hand-laminated charts for each drug category circulating the class as a study aid. Present a 500-page small animal medicine syllabus and witness those senior-year nerd books starting to fill up. We got good at stuffing information into our brains. If we hadn’t, we would fail our classes, our boards, and our patients. We might have even thought we were pretty hot stuff to have learned so much. Alas, the proud shall be humbled. It happened to me when I flipped on a television show and found myself struck dumb as I watched an astonishingly different kind of intellect on display. That show was MythBusters. Weird science I have long wondered why I have such awe for a show best known for explosive grand finales orchestrated by a madcap crew. I mean, the MythBusters team is just a group of special effects artists, not Nobel Prize winners. For any given episode, they build turkey cannons or remote-control rocket cars, or mechanical contraptions that accelerate ‘Buster the Test Dummy’ off a toilet seat. It seems to me, saving the life of an animal through medical skill should rate as high, or higher, in the annals of brilliance. Alas, I can’t help feeling abashed at my own inadequacy before their genius. I can do a spay, but I do not have the slightest idea how to turn an outlandish question into a step-wise experiment; how to break down the plan, fabricate the components, measure, analyze, re-fabricate, and re-analyze. In short, I do not know how to use the scientific method like they do. Wait a minute. Medicine is science. Shouldn’t MythBusters and medicine be cozy bedfellows? Why does their way of thinking feel so alien to me? I have given this a lot of thought since the first episode aired in 2003, and at last I know the answer. It is not because they think so differently, but because they think so similarly—just in the opposite direction. Let me explain. The perfect murder? My favorite episode questioned whether an assassin could use a bullet made of ice to kill someone and leave no ballistic evidence behind. I’ve seen this plot device in movies. It sounded clever, and I was mesmerized. I assumed making an ice bullet would be as simple as freezing water in a proper mold and crimping it onto a brass casing. It wasn’t simple. The ice cracked every time the team tried to pull it out of the mold. They used a wax encasement. No success. They switched it up to a gelatin capsule, but the ice projectile was simply too brittle. Myth: busted. Undeterred, the MythBusters revised their parameters again. They switched to a frozen meat bullet, which would theoretically melt into indistinguishable goo that would confound the medical examiner and leave the murder weapon a mystery. Even with the right mold and gelatin casing, the meat bullet shattered innocuously every time it was expelled from the rifle barrel. Myth: busted again. In every single scenario, the MythBusters team tested the myth by starting with a premise and then generating data to prove or disprove it. Genius of a different kind In contrast, veterinarians start with the data (clinical signs, laboratory findings, imaging results), then recognize the patterns in the data to generate the premise (a little thing we call a ‘diagnosis’). Did you notice that? Premise to data vs. data to premise. Same thinking, opposite direction. Let’s dive a little deeper into how we arrive at our coveted diagnosis. The single best tool veterinarians use to practice medicine is the SOAP (subjective, objective, assessment, and plan). Far from being just another snazzy medical acronym, the SOAP’s entire purpose is to organize massive amounts of information for optimal pattern recognition. We separate what the client reports from what we find on the physical exam. We filter and discard or link this information to form a problem list, then enumerate the known causes of each problem on the list. One by one, we choose diagnostic tests to rule the differential in or out. Rule-ins are grouped to become diagnoses, which direct us to courses of treatment based on reliable, repeatable past results. The SOAP mode of thinking (i.e. organizing data for pattern recognition) is precisely what makes medicine uniquely medicine, as opposed to any other science. Medical terminology itself reinforces the idea of pattern recognition in our field. We look for bronchoalveolar patterns on chest radiographs. Microcytic, hypochromic anemia is a biochemistry pattern of iron deficiency. Bilaterally symmetrical alopecia is a coat pattern indicating endocrine disease in dogs. Good golly, but the term “pathognomonic” refers to clinical findings so pattern-specific that they can only have one cause. Clinically, we rely on patterns learned through experience to drive us to the right course of action. I recall a feline patient who spiked a refractory high fever with upper respiratory signs and outrageously enlarged submandibular lymph nodes. This was no ordinary URI. It didn’t fit the pattern. We treated him with everything we had for two hopeless days. Then I realized he did fit a pattern—the Yersinia pestis case I witnessed during my sojourn through Gross Pathology during my senior year of veterinary school. I vividly remember the pathologist starting the necropsy, cutting into the freakishly enlarged submandibular lymph node of a rabbit, then stepping back and telling all the senior students to put our masks on, touch nothing, and leave the lab immediately. Yeah, I remember that. My feline patient ended up having virulent calicivirus, not the plague. But I was right. He did not fit the pattern of a simple URI. I raised the alarm in time for treatment to save his less-affected housemate with the confidence we were not endangering the pet owner or ourselves in the process. We often don’t appreciate the merit of one way of thinking until it is held in counterpoint to another. I like science; I love medicine. I love that health professionals get to improve lives and treat disease. I love that veterinarians make a real difference in the world. I love that veterinary school taught me how to think in a unique and profound way. It took the boundless creativity of the MythBusters’ scientific method to show me the artful efficiency and effectiveness of medicine’s pattern recognition. Without realizing it, I was storing away every fact taught in veterinary school, every anecdotal story read on VIN, every note taken during conferences to sharpen this muscle in my brain. So, the next time you find yourself fried at the end of a hard shift, trudging through medical records, SOAPing each patient by rote, take a step back to realize what exactly is in front of you: a great and mighty tool for ordering data to help Buster, even if he is the fat, lazy Labrador at your feet instead of the rocket-propelled test dummy of TV fame. Holly Sawyer, DVM, worked 19 years in small animal private practice before joining GuardianVets to train and coach the veterinary professionals who deliver 24-hour triage support to hospitals.
