The architecture of diagnostic research

Sirs,

Sackett DL and Haynes RB’s article (The architecture of diagnostic
research, BMJ 2002;324:539-541, 2 March) in my mind, is of paramount
importance for physicians who are working at the bed-side, in their day-to
-day practice, in a world otherwise ruled by high technology. However, I
think that there is something wrong at the base of their argumentation,
which unfortunately has become “the rule” of present “clinical” medicine.

For instance, in their Summary points, one can read: “Are patients with
certain test results more likely to have the target disorder?”, and then
“Do test results distinguish patients with and without the target disorder
among those in whom it is clinically sensible to suspect the disorder?”.

Due to the fact that the diagnosis of BNP blood concentration is
primarily “clinical” (See HONCode ID 233736
http://digilander.iol.it/semeioticabiofisica), in my opinion, the authors
know only the old, traditonal, acadèmic physical semeiotics and clearly
ignore or overlook the developments, occured in the past 50 years, in
physical semeiotic field (1,2,3). In fact, nowadays, all diagnoses must
be and can be first “clinical” and then corroborated by laboratory and/or
image department (performed always in patients rationally selected). In
addition, under such circumstances, if a test results pathological, but
clinical examination, i.e. the clinical result of biophysical semeiotics,
is normal (I ask “why” an individual, evaluated at the bed-side in healthy
condition, must undergo an instrumental or laboratory examination) and
this “patient”, moreover, is working all day long and is even able to
perform physical exercise, physician is allowed to state that in such
(really numerous) cases, laboratory and image department are wrong. To
conclude, the end of physical (or better speaking, biophysical semeiotics)
represents the end of clinical Medicine.

Sergio Stagnaro MD., Active Member NYAS.

1) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and
Myocardial Oxygenation evaluated clinically with the aid of Biophysical
Semeiotics in the Diagnosis of ischaemic Heart Disease even silent. Acta
Med. Medit. 13, 109, 1997.

2) Stagnaro-Neri M, Stagnaro S., Valutazione clinica percusso-ascoltatoria
del sistema nervoso vegetativo e del sistema renina-angiotensina,
circolatorio e tessutale. Arch. Med. Int. XLIV, 3, 173-178,1992.
(Infotrieve)

3) Stagnaro-Neri M, Stagnaro S., Valutazione clinica percusso-ascoltatoria
del sistema nervoso vegetativo e del sistema renina-angiotensina,
circolatorio e tessutale. Arch. Med. Int. XLIV, 3, 173-178. (Infotrieve)