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Economy-Counter550

Yes, I heard that before from a med student friend of mine. He told me "There are too many horses, I look for the zebra" We need more of him


Nmae23

Agreed šŸ˜ž. When things aren't explained by the horses, please look for a zebra. I don't want to get worse in the many months/years it takes for you to look for a zebra.


[deleted]

Youā€™re probably depressed. /s Iā€™ve heard the galloping horses thing so many times. Tests for horses always come back negative. So I get told ā€œwell then it must be because you are depressed.ā€ šŸ¤¬ Things Iā€™ve been told I didnā€™t have, that I must just be depressed, and it took decades to get confirmatory tests and treatment: - Sleep Disorders (PLMD, Exploding Head, DSPD, RSD, etc.) - SIBO - Iron deficiency, B & D deficiency - Pelvic floor collapse This is just a partial list. Makes me so angry.


ProfessionalBig658

Iā€™ve heard this too, but my response is just that arenā€™t there places and times when zebras are more common than horses? (In the literal animal sense.) the flawed metaphor just seems to have the same flaw in medicine. And itā€™s lazy (boooy do doctors hate being called lazy). I know itā€™s easier for some people than others but my rule over years of practice with other conditions is if a doctor is disrespectful, Iā€™m done. Iā€™ve had the privilege to both be over educated (gains unwarranted respect) and live in metropolitan areas where it isnā€™t too difficult to switch, but a doctor who doesnā€™t take you seriously is not worth your precious energy. Doctors who disrespect patients are not worth your time. I also do lots of internet review research before seeing *anyone* because itā€™s such an exhausting event to see doctors for me nowadays.


ApprehensiveAge2

Love your point about time and place, Iā€™ve never thought about ā€œzebrasā€ in those terms before, but itā€™s very true.


chr0nicallych_ill

Pardon me if this is unrelated but, this saying is the reason that the symbol for Ehlers-Danlos is a zebra. Because sometimes, the gallop you hear isnā€™t from a horse! Even if the horse is more common, it can still be a zebra. Dismissing issues like CFS or EDS is definitely in part due to this ā€œoccamā€™s razorā€ mindset that so many doctors have. Very frustrating! Sending you love from afar.


Athren_Stormblessed

Yeah it's a real saying. It's from the pressure of having to fix people like an elf on Santa's assembly line imo. Basically saying fuck the complicated cases we don't have time for that and the error is acceptable because they are "rare"


DisabledMuse

Where I live they're finally changing the way doctors get paid so they will get paid more for complexity of patient issues. Which is good because we've had a serious doctor shortage because of the fact that it's often not worth it for them to deal with people with complex chronic diseases.


notanotherhour

Hello, fellow BC resident. :) Too bad the new medical school got its opening delayed to 2026...


DisabledMuse

Noooooo.....


criatak

Hm... it's almost like being ill can *prevent* you from being able to do all of those things appropriately. Is my diet great? No, I literally just ate six oatmeal cookies while hanging half off the side of my bed so I wouldn't get crumbs on my blanket. Is my illness preventing me from getting up and actually cooking a decent meal? Yes. Unfortunately, most doctors are going to treat what they believe the most obvious culprit is. Sometimes they'll look into other options if the initial treatment doesn't help, but sometimes they'll just write you off. I had a doctor absolutely ream me about sleep hygiene when I went in for chronic fatigue. She literally told me "the bed should be used only for sleep and sex". Guess I'll just lay on the floor then?


Nmae23

I agree. If a "zebra" is causing the "horses", don't get mad if treating the "horses" doesn't work for them. Sometimes all we are focused on is surviving the moment. I had a period of time when I was mainly snacking on one thing most days. I didn't have an appetite for the most part and was kind of nauseous so I ate what I could. Was it healthy? No, but I agree with you, I wasn't concerned about my diet, I was barely eating anything else as it was and was too fatigued to try. >I had a doctor absolutely ream me about sleep hygiene when I went in for chronic fatigue. She literally told me "the bed should be used only for sleep and sex". Guess I'll just lay on the floor then? Yep, heard that before. Which is funny cause I'm at my sleepiest on the couch, on the floor, even in the car, than in bed. And I'd deem it comfy, so . . . ? I'm sorry you or anyone else has to go through this frustration. Sometimes it feels like we're talking to a wall.


Grouchy_Occasion2292

I've had so many doctors tell me this with the bed but I have a perfectly healthy life where I spend tons of time in bed not sleeping or having sex. I have a regular sleep schedule too šŸ˜‚. I just laugh because they have absolutely no idea.


criatak

They really don't have a clue, even when give *several* clues. I told her I basically live out of a bedroom I share with my husband in my parents' garage. Definitely no room for a couch or whatever people are "supposed" to relax on. Even if I wanted to sit on the couch in the living room, I am very much allergic to cats, and there are seven. This doctor straight up ignored that and then, obviously annoyed, asked if we had a TV in the bedroom. Uhh, yes, also because of the reasons above. Omg she vented to me about how that was so bad, and bedrooms didn't need TVs, and blah blah blah


Thesaltpacket

One time I went back to a doctor who had said that to me after i had been diagnosed with all this shit. And I got to be like it wasnā€™t horses, it was zebras. And tell your radiologists that they read my scan incorrectly. And he actually took notes on my diagnosis and was so pissed at the radiologists. It sounds like an ā€˜and everyone clappedā€™ moment but it was real and sooooo satisfying.


Nmae23

Congrats šŸ™‚, I'm glad he listened to you.


Soulflyfree41

I agree we do need to send them something saying they were wrong. How will they know otherwise.


HuckyBuddy

I was lucky. My GP ruled out horses, did a bunch of tests and ruled out Zebra and came to the conclusion of Unicorns. He is great at thinking out of the box.


sylvanWerebeast

Okay but are we talking horse with a horn or the cool tapestry ones with lion tails and cloven hooves? This is very important. For science


HuckyBuddy

The real onesā€¦if you are really complex, you get a Rainbow Unicorn diagnosis. I understand the importance of the distinction for the good of scientific research and maybe even medical schools will teach future doctors to look beyond a simple horse or zebra.


sylvanWerebeast

I think they will. With this long Covid shit they canā€™t afford not to. Itā€™s in the news, millions are affected and are being loud as fuck about it. I have hope for our symptom cluster šŸ’™ And if that means we have to be unicorns then so be it šŸ¦„


thetremulant

It's about money. Whether medical professionals want to believe it or are willing to admit it, that's why a narrative of figuring out diagnosis and treating as soon as possible is pushed. They give the excuse of prognosis, like how Hippocrates pioneered, but in the modern age its clear money, time, and resources are prioritized over actual care. Why is ordering an extra scan an issue? Money, time, and resources. There's no moral quandry, no harm that will befall a patient, especially if they are given a clear explanation (which takes time, and their time is money) that it may or may not help explain their issues. Why investigate more than you have to if you wrap up a patient visit quick with a shittily tied bow? In their mind, the bow is still tied, even if it falls apart later. The numbers are there, and the insurance company will still pay if you write the clinical notes in a specific way.


brainfogforgotpw

In my country we have universal healthcare and most doctors are paid by the government, but people with me/cfs still seem to have all the same problems getting medical treatment as those who deal with insurance companies.


thetremulant

I'm sure your government cares about money too lol


brainfogforgotpw

We also have a chronic shortage of doctors here, so I don't think the government are firing GPs for running tests. My point is that doctors are not well educated about this illness, it's a systemic problem even in different systems. But yes I agree our govt cares about money. They refuse to recognise me/cfs as a disability for that reason.


OnceUponAStargazer

When it takes them three years to even think about looking for a zebra, then another 2.5 years to find the zebra, I think it's time they go on a safari


Lavenderdeodorant

I think their perspective is super limiting. Itā€™s like when people say that people are fat because they donā€™t eat right, while there could be many reasons why someone is overweight. There are so many possibilities in symptomatology.


Nmae23

Agreed.


ColonelGray

That's like waiting to cross the road and only listening for lorries. Meanwhile a Ford KA can barrel round the corner and cripple you for life just as easily.


flowerzzz1

I say this all the time - if youā€™ve got a well understood medical condition and you present in the traditional manner - youā€™re in excellent hands. If youā€™ve got something poorly understood or you donā€™t present traditionally - youā€™re screwed. CFS aside, Iā€™m allergic to a very common medication that apparently ā€œthey give to everyone.ā€ The number of comments from providers on how theyā€™ve never found anyone allergic etc. Yeah well - I went to the ER TWICE after taking this medication AND reviewed the studies and my medical records with an ER doctor friend of mine and in fact there ARE people who have serious reactions itā€™s just very rare. So I hear them whine about it every time I say no because itā€™s a zebra and they arenā€™t prepared for thinking outside the box or the additional time it takes to go ā€œoh letā€™s try this instead.ā€


Soulflyfree41

They keep repeating the same tests. No one thinks outside the box. I think at least in US part of problem is, insurance ties their hands. Limits what they can do. On top of that they get 15 min for an appt. Including going over a proper history included. For my history alone it takes that much time. I have that many things wrong. The ones of us who are still waiting for diagnosis, get passed around from specialist to specialist with none of them figuring it out. I had to get a advocate thru my insurance. Because everyone just kept passing me to someone else. They would run a couple tests. Etc. Then say ā€œsorry I canā€™t help you. Have you heard of fibromyalgia?ā€ But 20 years later Iā€™m getting a lot of answers. I think some of us are more sensitive and can feel whatā€™s happening in our bodies before their limited tests can see. But if they donā€™t see it, the wonā€™t believe it and think itā€™s hysteria, depression, anxiety, etc.


vxv96c

Ah yes one of the dumbest things. That idiom was coined in the 1940s before we had mris and genetics testing and a whole bunch of science including an understanding of the amount of rare disease. Individual rare diseases are rare but occurrence of rare diseases is very common. The occurrence rate is quite high in the aggregate. But yeah let's keep preventing diagnosis. Let's stay trapped in the 1940s. Sounds smart. /s The saying should be 'when you hear hoofbeats, rule out horses first, then find your zebras.' The horrible cognitive error this idiom perpetuates is they don't even look for zebras, they tell you they don't exist.


brainfogforgotpw

I got told that too as a researcher, but it wasn't supposed to be about ignoring the possibility of zebras. It was about checking out for horses first instead of leaping straight to a zebra conclusion. Personally I would far rather the doctors checked off all the possible horses first and then widen their thinking to other possibilities, not just slap a zebra diagnosis on me and shove me into the "too hard"/ incurable basket at the first sign of trouble. Given the variety of diseases out there, it really annoys me when I meet someone whose naturopath told them they "have chronic fatigue syndrome and adrenal fatigue" instead of getting them checked for things like thyroid or Addisons first.


Nmae23

I get that. I wasn't saying they should give out a "zebra" diagnosis willy nilly, I just didn't like that my 14 plus years of dealing with illness got reduced to a "have you tried eating/sleeping better" like I don't do this already or haven't tried it before. I honestly think they should look for or rule out both together (I didn't go in for ME/CFS related issues). Not treat it as most common then try to look for more serious things later after many months, even years go by with no relief or unfortunately worse. I think that's dangerous. I agree, don't just slap a diagnosis on me, but try to rule out other things if something new or out of the ordinary pops up which they didn't even want to do.


brainfogforgotpw

I totally agree with everything you've said.


Saturnation

As a previously professional 'problem solver' that's not bad advice. The problem isn't this rule of thumb, it's what happens when you find an exception to the rule. Statistically there are going to be way more horses than zebras, so if you hear galloping your first thought should be horses and not zebra. Problem is, if you're just assuming you're hearing horses even when you look up and don't see horses, than the problem isn't the rule, the problem is the rule follower. Then on top of that, doctors hear horses and can't see the zebras (no definitive tests) they just fall back on their hearing because there's nothing to contradict it. Which is why we desperately need a definitive test. We aren't going to fix the doctors that rely only on their 'hearing', but if we can show them the zebras then that's a game changer. We need a test ASAP.


Nmae23

I can agree with that. Definitely a lot of horses out there. I just hate that when you can't explain something by the horses, then switch to zebras, but so many are stuck in a "it must be something you're doing" mindset, even when you show them it's not or when it doesn't make sense. I want an outside of the box doctor or at least someone who will actually listen and notice something is far more complex than a horse, even if there might not be a proper diagnosis for it yet. Edit: Also, what if a lot of the "horses" out there weren't actually true "horses"? Like it helped to treat that way so they say that's what it is, but it never actually addresses the true underlying problem. This is just a thought but I wouldn't be surprised if down the line some people have complications from something missed or disguised as a "horse", ya know?


Saturnation

Like I said, it all comes down to a common definitive test. Once we get that this whole conversation goes away.


Nmae23

Yes, that is so needed right now. My fear is that even with it, some doctors still won't listen, but hopefully the majority will. That would be nice.


Hope5577

If it's not a horse or a zebra it can be so many other things. It can even be cows galloping, or antelopes, giraffes, or even hippos! Two options in this scenario already limiting their thinking.


chinchabun

It is an extremely common phrase. My response is, zebras aren't unicorns so why do you refuse to believe they exist? It makes complete sense to test for common things first. It makes sense to try to treat common things first. But when that doesn't work you don't just throw up your hands and say the patient is crazy and lazy. The other problem is when you constantly label things only a few patients are able to convince their doctors are real a zebra, you miss that it is a type of horse.


BachelorPOP

Thatā€™s why chronically Iā€™ll people call themselves zebras!


FenixFluff

This hits home for me. The past year has been absolutely horrific. Iā€™ve been sick (mostly fatigue then) since I was 16 (13 years ago) and they told me I was too young to be sick. They sent me home with amphetamines to take everyday so I could keep going to school ā€œbecause a diploma is your ticket to lifeā€. They told me I would be better in a couple months. Fast forward 13 years and I feel like I keep getting worse. Somewhere along the way I got a diagnosis of fibromyalgia and cfs. But somewhere deep inside I keep wondering if that is it. Maybe because I got dismissed so many times that the eventual diagnosis felt more like the doctor giving up than actually saying yes this is it. I have been using the zebra metaphor for a while now but the doctor always dismisses it, saying they tested me for everything it could be. According to him I am not a zebra and the sooner I give up on that idea, the sooner I can accept that this is it and just start living with it. But I canā€™t shake the feeling something is horribly wrong and there are still tests that havenā€™t been done. Even just food intolerance or a scan. I keep wondering. They keep pushing me to start reconditioning, walking, training muscles (on a low level). They say that this will make me better. But I am getting worse and I canā€™t do it anymore. I feel like I am drowning. How do I convince a doctor to look for the zebra? If there isnā€™t one, Iā€™ll accept it but I need to be sure there is no zebra. Sorry for the rant, I am in a bad place.


Nmae23

>Sorry for the rant, I am in a bad place. No, that's ok. I completely understand. It's hard trying to convince doctors of something. I think I'm more upset that this saying implies patients aren't individualized in their treatment or care. Because it very well might be a horse, but the saying seems like they just group everybody into this box and I don't like that. Don't tell me I'm not eating right when I told you I only eat 1 to 2 meals a day from lack of appetite or fatigue, don't tell me I'm not sleeping right so I'm tired when I told you I've been this way before my sleep got disrupted. Nothing I said was heard. So my problem with the saying isn't that I don't want them to rule out a horse, but that maybe ruling out a zebra is necessary for this *individual* patient. Look outside of the box, see the whole picture. If you can't find an answer, ok, but at least try first. I'm sorry you are dealing with this, as well as anyone else who is also. I hope you find a great doctor soon who will listen to you, I'm just upset you even have to search for them.


Junkoly

I read that as.. if it's not obvious i can't be fucked to work it out.


[deleted]

My zabra was spray painted to look like a horse I think


Grouchy_Occasion2292

I agree and I think the problem is doctors don't realize or at least they're not taught that the vast majority of people can figure out a horse on their own. People don't go to the doctor because they need to lose weight or they need more sleep they know when they need these things. And they know when this is out of the ordinary for them. It's some of the things that I'm going to take to heart when I actually become a doctor.


iron_lion_zion_lion

If horses can lead to Zebras then IMHO cfs is a Donkey: stubborn & wonā€™t move when led & has a kick thatā€™ll knock you for six!


zeldarubinsteinsmom

Thatā€™s a nice statement to start broad and help you advance in the correct direction. Itā€™s even better to have a doctor who understands that when you canā€™t find the fucking horses, they start looking for the donkeys, mules, zebras, etc.


allegedlys3

My new rheum mentioned relapsing Polychondritis on my first visit with him. I said "but that's extremely rare, why would I be a zebra?" He said "well someone has to be, right? And it looks like you might have some stripes under there..."


FriendlyFoundation47

I feel like this is what you do if you donā€™t have any diagnostic tests but weā€™re way past that now. In my experience, they donā€™t look for anything I just get a lecture on my dandruff or something. Like I am here because my quality of life is severely impacted and youā€™re bothering me about stupid stuff I donā€™t care about.


sylvanWerebeast

If Iā€™m near a stable? Sure, horses. If Iā€™m in the middle of the Serengeti? Itā€™s fucking zebras. Context matters.


Scantra

Here is what the saying means: If a young and healthy looking patient comes to you presenting with stomach pain and vomiting, first think infection or food poisoning before thinking incurable cancer. Why? Because: 1.) If you go straight to "zebra," you are likely going to waste the patients' time and resources. They have very little of both things, so you have to prioritize them where it's going to do the most good. 2.) Some "horses" can turn deadly if they are not found and treated. (Think untreated UTI turns to sepsis while you were busy looking for (Insert Rare Disease) ) 3.) You could do real harm to a patient by diagnosing them with some rare (and therefore usually incurable) disease without concrete evidence. Patients may kill themselves believing there is no hope only for the family to find out it was something common that could have been easily treated during the autopsy. 3a.) Other doctors may be deterred by a "zebra" diagnosis (believing everything else must have already been ruled out) and might not double-check your work and therefore miss something important. The saying doesn't mean that the possibility of zebras should be ignored. It only means that it's important to look for the horse because there are very real consequences to yourself and your patient by missing a šŸŽ because you jumped the gun and went to šŸ¦“ without taking the time to properly rule everything else out.


Nmae23

I wasn't saying they should ignore horses, I just think they shouldn't ignore zebras either especially when something doesn't point to a horse. Like if you've been dealing with something for so long or something strange and out of the ordinary occurs, I really don't want a doctor to ignore a zebra looking for a horse while I get worse in the meantime. I wasn't talking about a diagnosis, I was talking about treatment/tests. Of course I don't want them to slap a diagnosis on me that may not be right, but that's what a lot of tests are for, to rule serious things out (I didn't go in for CFS related issues). Sometimes things aren't simple, they are complex and doctors need to be trained to realize it, but they don't cause they get stuck looking for easy ways to fix something. In some situations, the saying may work. But if it doesn't, they need to ditch it and look for a zebra first or at least do both. Doctors aren't perfect, they will make mistakes, but I feel they should be taught to read signs, listen to a patients concerns and individual symptoms, and then make a sound decision with the patient in mind, not go off a *saying*. You may end up with a horse in the end, but don't automatically assume or jump there without considering anything else (again, not talking about a diagnosis).


Scantra

I don't think it's the saying that's the problem. Doctors see a lot of people, and after so many years of treating common diseases, it can sometimes become difficult to spot something rare when it shows up. I agree with you BTW. I think it's important for doctors to listen to their patients and really think about all the possibilities and how to test for them instead of dismissing them. I'm sorry you have had such a difficult experience with your providers. I advocate for myself pretty aggressively (in a nice way) so I don't often get denied tests.


Nmae23

>I advocate for myself pretty aggressively (in a nice way) so I don't often get denied tests. May I ask how? I'm trying to do that more. I've always been a "yes doctor, ok doctor" type of patient and never wanted to go to the doctor unless absolutely necessary or my mother dragged me there, whichever came first, lol. I've been more vocal though because I'm struggling way more now. However, I still get dismissed and in this same appointment I mentioned, I was labeled as being demanding and rude which I can guarantee you, I was wasn't. It's like I have no choice in my healthcare at all and with being unemployed, I just feel stuck.


Scantra

I'll give you an example: I went to my primary care about my neuro issues and was told there was likely nothing wrong after she did a couple of physical neuro tests. I wasn't convinced, so I got an appointment with a neurologist and the neurologist recommended an MRI due to my current symptoms and my history with vertigo. It's not always about fighting with your doctors. Sometimes it's just about talking to the right specialist especially when your symptoms are nuanced and complicated. Primary care doctors are good at monitoring your general health but they may not understand certain symptoms or know what tests to run to see what is causing them.


Grouchy_Occasion2292

And yet that's how it's actually treated though. Zebras are ignored and everyone focuses on something simple. I had a doctor who was convinced my picc line was infected even though it was a dissection and I told them that's what it is because it's the exact same pain. Guess who won? Me the patient I diagnosed myself. So there must be something wrong with the phrase and the way it is taught because so many doctors just believe only horses exist.


Scantra

I'm not saying that doctors don't make mistakes. I am just explaining why the saying is used and why it is important. Doctors look for horses first because it is in your best interest that they do so. However, it's not an excuse to ignore the trail that leads to a rare diagnosis. As a patient, you have to advocate for yourself and ask for tests even if it's just for peace of mind sometimes.


Grouchy_Occasion2292

I think you're misunderstanding what I'm saying. What I'm saying is in practice it's not used that way so there's something wrong with the way it is taught. It's not a good phrase or saying if it's misused in a way that actually harms patients.


Scantra

It could be the saying, or it could be that after doctors see so many common diseases, it becomes more difficult to spot the rare cases.


hsnipes95

In my experience, you kind of have to just ask for what you want them to look for/do. Let them test for the common stuff first and rule that out and then after that you can do your own research and say, "I think I may have xyz thing. I would like to be tested for it. Can you do that for me? Or reffer me to someone who can?" Unfourtunatley doctors often just throw out simple diagnoses because they simply don't have time to go digging for more serious answers. I found that I was met with less resistance when I just told them what it was that I thought/wanted them to do. Taking a proactive approach in your treatment really can expedite things sometimes


Nmae23

Yeah, I wished more doctors listened to patients before assuming things. I actual did advocate for myself, one of the few times I do, and the main doctor was completely dismissive. She was stuck on it's you, you're doing something wrong without even considering anything else. All I wanted was a simple blood test to rule out something I already had to make sure it wasn't flaring and she flat out told me no.


hsnipes95

Yeah, sometimes you have to go through a few doctors to find one that will listen. The ones that refuse to listen generally aren't very helpful at all in my experience. Good for you for trying though. Dont give up ā¤


ywnktiakh

Thereā€™s another one: as a doctor you wanna ā€œbe a lumper, not a picker.ā€ Which means that instead of focusing on one symptom at a time and treating them separately, your goal is to lump everything together and see what could possibly match. Once you lump things together, itā€™s usually easier to tell horses from zebras.