A grain of sand.

I am a glutton for podcasts, occasionally medical, but often way off this mark (sociology, philosophy & rugby league would fall into this category), yet they frequently play into each other. Some of you will recall this, as I note that when I can’t concentrate on a podcast, I know I’m becoming overloaded/over worried and need to step away from stuff to regain my good mental health. Podcasts are my pants drawer.

However, my own state of mind is not the key in this entry, but an ancient philosophical problem.

The Sorites Paradox.

Here’s one grain of sand. Is it a heap of sand?


OK. Add another. Is it a heap of sand?

No? … and repeat …

At what point does it become a heap? How can 279 grains not be a heap, but 280 be a heap of sand?

Now take this to our world … why do we decide that a wheezy, snotty bundle of RSV-dripping joy can go home at 92% O2 sats, but must stay in at 90%? Is there any sense in this?

(There’s a trial that’s looked at using a sats machine that lies – tells you the sats are ~3% higher than they are – in this situation and showed no difference in outcome when the ‘low sats’ babies got sent home APART FROM the ‘true reading’ group got longer hospitalisations.)

But even more interesting than that is the philosophy-in-life choices we make liminally – at the edges. What are the thinking processes we use when we decide a platelet count is low enough to transfuse, or a cough prolonged enough to request a chest x-ray, or a referral to our child protection colleagues cannot wait for another visit with mucky T-shirt and too-tight shoes? We need to apply this same thinking to any categorisation in medicine; why was ‘that’ grouping used for the multivariate regression analysis, for example?

Have a good read of the Stanford blog entry to work your way through it – its really worth it – and if you get hooked, try The History of Philosophy (without any gaps) too.

– Bob Phillips



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