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PRACTICE: Geoff Norman, Kevin Barraclough, Lisa Dolovich, and David Price Iterative diagnosis BMJ 2009; 339: b3490 [Full text]

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Standing the test of time.

John P Coffey   (25 September 2009)

The seventh strategy

Mark A Vorster, SG5 1LL   (30 September 2009)

Standing the test of time. 25 September 2009
John P Coffey, Consultant Radiologist Royal Preston Hospital, PR2 9HT Send response to journal: Re: Standing the test of time.	As a diagnostician, I feel entitled to solicit comment from Dr. Norman on his perspective on the (literal) ultimate diagnostic procedure, namely necropsy. This is a diagnostic technique that has not merely stood the test of time, over centuries, but is a clear, time dependent, diagnostic test. Diagnosis, in this situation, is of course seldom reached inductively or intuitively but all too often, "heuristically". No article on diagnostic method can ever be considered comprehensive without a treatment of this important facet of diagnosis. Competing interests: None declared
The seventh strategy 30 September 2009
Mark A Vorster, GP Regal Chambers Hitchin, SG5 1LL Send response to journal: Re: The seventh strategy	This paper is an excellent descripton of the methods used every day by doctors in the diagnostic process. However a seventh strategy that may help reduce cognitive error is the use of appropriate information technology. This is a way of bringing pre-existing clinical knowledge into play just when it is needed. Obviously the information or decision support presented must be of sufficient quality and be part of the clinician workflow to prevent disruption to the consultation. However it is also important that decision support is viewed as just another tool in the diagnostic armoury. Competing interests: None declared