Why clinicians are natural bayesians: Clinicians have to be bayesians

doi:10.1136/bmj.330.7504.1390-c

BMJ 2005;330:1390-1391 (11 June), doi:10.1136/bmj.330.7504.1390-c

Letter

Why clinicians are natural bayesians

Clinicians have to be bayesians

The first 150 words of the full text of this article appear below.

EDITOR—Clinicians are natural bayesians when it comesto diagnosis.¹ They have to be. The alternative approach mightbe to use the methods of classical hypothesis testing, but probablyonly once.

The Neyman-Pearson diagnosis of coeliac disease

(Assume that the sensitivity and specificity of transglutaminaseIgA are both 95%.)

Parent: Well doctor, have you got the result of the test yet?

Doctor: Yes I have. When you brought little Johnny in with weightloss, short stature, and diarrhoea I thought it was worth checkingfor coeliac disease, and the test has come back positive.

Parent: Does that mean he has coeliac disease?

Doctor: I can't be certain, but it is likely.

Parent: Well, how likely?

Doctor: I can't actually tell you that, but given that he doesnot have coeliac disease, there was a 95% probability that thetest would have been negative, and it in fact was positive.

. . . [Full text of this article]

Robert McCrossin, consultant paediatrician

Department of Paediatrics, Hervey Bay Hospital, QLD 4655, Australia Robert_McCrossin@health.qld.gov.au

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