A primer on the precision and accuracy of the clinical examination
Article Abstract:
Many initial diagnoses can be made on the basis of a patient's medical history and physical examination. For example, a patient's responses to the CAGE questionnaire and the doctor's observance of a few signs of alcohol abuse can indicate that the patient has a dependence on alcohol. However, doctors must know the precision, the accuracy and the likelihood ratio of the different diagnostic tests they can perform during the history and physical. Precision measures the likelihood that two doctors using the same test to examine the same patient would agree that a sign or symptom is present. Accuracy is measured in terms of sensitivity and specificity; sensitivity measures how well the test detects a condition when it is present and specificity measures how well the test excludes the condition when it is absent. The likelihood ratio tells the doctor the odds of a symptom or sign occurring in a patient with the condition, compared to someone without the condition.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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The science of the art of the clinical examination
Article Abstract:
Studies have found that most diagnoses can be made during the history and physical. In addition, many diagnoses can be ruled out at this time. Patients can also be identified at an early stage of their disease, when it may be easily treated. The editors of JAMA, the Journal of the American Medical Association, have begun a series called The Rational Clinical Examination. Each article will focus on a specific diagnostic test that can be performed during the history and physical. The article will discuss the best way to apply the test, and will state the precision, sensitivity and specificity of the test. Most of these values are known for laboratory tests, but they have seldom been applied to tests that can be used during the physical examination. Some commonly used tests may be shown to be of little value, while others may indicate a need for further research.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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The clinical examination: an agenda to make it more rational
Article Abstract:
More research is needed to determine if certain signs and symptoms seen during a physical examination can accurately convey a diagnosis. The efforts by managed care to reduce health care costs by eliminating unnecessary diagnostic tests will make the physical exam more important. Yet there is little research to determine the accuracy of the physical exam. One way to gather such information is to have physicians evaluate the findings on physical exam that led them to enroll a patient in a clinical trial. Health care organizations may be the best groups to do this research.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1997
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