Evidence based diagnosis: We may need to be open to new ideas

doi:10.1136/bmj.333.7567.549

BMJ 2006;333:549 (9 September), doi:10.1136/bmj.333.7567.549

Letter

Evidence based diagnosis

We may need to be open to new ideas

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

EDITOR—If evidence based diagnosis is still in the darkages, as Delamothe writes,¹ then so is evidence based treatment.The doctor's job is to choose the right treatment. If the diagnosisis wrong then the treatment will be wrong. Inaccurate diagnoseswill also affect clinical trials. A treatment may be "evidencebased" because it has worked in a published study, but somepatients who would have responded might have been left out becauseof diagnostic inaccuracy while some patients with no prospectof responding might have been included incorrectly.²

Evidence based diagnosis is about convincing others using sharedrules of evidence that a diagnosis (and its implications interms of treatment) should be accepted by others. Evidence isgathered from the individual and from groups of patients.³ Evidencebased diagnosis means specifying the individual's facts in additionto pointing to facts relating to that diagnosis in the literature.⁴

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Huw Llewelyn, consultant physician

Department of Endocrinology and Diabetes, Great Western Hospital, Swindon SN3 3BB deh.llewelyn@orange.net