[The author responds:]
In my review of the Physician Achievement Review initiative launched in Alberta, I discussed aspects of performance and quality by placing them within the context of quantitative analysis. The spirit of that analysis is to be scientific in its inquiry, implementation, and evaluation. As a guiding principle I proposed that such a series of steps be undertaken with "parsimony" in mind, or parsimoniously.
The golden rule of science is, indeed, that of parsimony. The Law of Parsimony, also called Ockham's Razor, goes back to the 14th century; William Ockham (died circa 1349) stated that non sunt multiplicanda entia praeter necessitatem, meaning that one should not increase, beyond what is necessary, the number of entities required to explain anything. This law, used sharply by Ockham (hence the razor), assumes that simpler explanations are inherently better than complicated ones. The scientific method of hypothesis generation and testing relies heavily on this powerful tool. In its recommendation to cut to the essence of things, the Law of Parsimony has shaped Western scientific thinking from Galileo to Einstein, who adapted the law as "make things as simple as possible - but no simpler." Epistemological in nature, the principle can be interpreted as saying that simpler models are more likely to be correct than complex ones.
The Law of Parsimony has also been used in the context of the definitions of quality health care in a seminal work by Donabedian.1 He stated that "the use of redundant care, even when it is harmless, indicates carelessness, poor judgement, or ignorance on the part of the practitioner who is responsible for care. It contravenes the rule of parsimony which has been, traditionally, the hall-mark of virtuosity in clinical performance."1
The societal dimension of parsimony is also critical to health care: providing the appropriate care, at the appropriate time, without waste is the responsibility of the health care provider, who should take into account both quantitative and qualitative aspects of diagnosis, patient management and resource utilization.
It is within the context of scientific rigor, clarity of causal relationships and appropriate decision-making that I have proposed that we should be "parsimonious." The scientifically trained mind functions at its best when the desk is cluttered but the decision paths are stingily chosen.
Reference
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