Br Med J  1975;2:486-489 (31 May), doi:10.1136/bmj.2.5969.486

Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.

To evaluate the relative importance of the medical history, the physical examination, and laboratory investigations in the diagnosis and management of medical outpatients some physicians recorded their diagnosis and a prediction of the method of managementafter reading the patient's referral letter, again after taking the history, and againafter performing the physical examination. These diagnoses and predictions were compared with the diagnosis and method of management which had been adopted two months after the patient's initial attendance. A diagnosis that agreed with the one finally accepted was made after reading the referral letter and taking the history in 66 out of 80 new patients; the physical examination was useful in only seven patients, and the laboratory investigations in a further seven. In only one of six patients in whom the physician was unable to make any diagnosis after taking the history and examining the patient did laboratory investigations lead to a positive diagnosis.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Phelan, M., Blair, G. (2008). Medical history-taking in psychiatry. Adv. Psychiatr. Treat. 14: 229-234 [Abstract] [Full text]  
• Ranji, S. R., Goldman, L. E., Simel, D. L., Shojania, K. G. (2006). Do opiates affect the clinical evaluation of patients with acute abdominal pain?. JAMA 296: 1764-1774 [Abstract] [Full text]  
• Fallon, K E, Gerrard, D F (2006). Clinical utility of blood tests in elite athletes with short term fatigue * Commentary. Br. J. Sports. Med. 40: 541-544 [Abstract] [Full text]  
• Dames, S., Tonnerre, C., Saint, S., Jones, S. R. (2005). Don't Know Much about History. NEJM 352: 2338-2342 [Full text]  
• Cornia, P. B., Lipsky, B. A., Dhaliwal, G., Saint, S. (2004). Red Snapper or Crab?. NEJM 350: 1443-1448 [Full text]  
• Hershey, C. O., Grant, B. J. B. (2002). Controlled Trial of a Patient-Completed History Questionnaire: Effects on Quality of Documentation and Patient and Physician Satisfaction. American Journal of Medical Quality 17: 126-135 [Abstract]  
• Bergus, G. R., Chapman, G. B., Levy, B. T., Ely, J. W., Oppliger, R. A. (1998). Clinical Diagnosis and the Order of Information. Med Decis Making 18: 412-417 [Abstract]  
• Wagner, J. M., McKinney, W. P., Carpenter, J. L. (1996). Does This Patient Have Appendicitis?. JAMA 276: 1589-1594 [Abstract]  
• Realini, T., Kalet, A., Sparling, J. (1995). Interruption in the Medical Interaction. Arch Fam Med 4: 1028-1033 [Abstract]  
• Woloshin, S., Bickell, N. A., Schwartz, L. M., Gany, F., Welch, H. G. (1995). Language Barriers in Medicine in the United States. JAMA 273: 724-728 [Abstract]  
• Kroenke, K., Spitzer, R. L., Williams, J. B. W., Linzer, M., Hahn, S. R., deGruy, F. V. III, Brody, D. (1994). Physical Symptoms in Primary Care: Predictors of Psychiatric Disorders and Functional Impairment. Arch Fam Med 3: 774-779 [Abstract]  
• LIPKIN, M. Jr., QUILL, T. E., NAPODANO, R. J. (1984). The Medical Interview: A Core Curriculum for Residencies in Internal Medicine. ANN INTERN MED 100: 277-284 [Abstract]  
• McIntyre, J. S., Romano, J. (1977). Is There a Stethoscope in the House (and Is It Used)?. Arch Gen Psychiatry 34: 1147-1151 [Abstract]  

Online poll

Find out more on doc2doc >>