The medical history as a diagnostic technology

Abstract

The medical history is a powerful diagnostic technology. However, in seeking to establish an appropriate balance between the history and the other diagnostic modalities more explicit consideration must be given to the performance characteristics of the medical history. Building on recent work undertaken in the UK and elsewhere in Europe it is now feasible to develop a library of setting-specific likelihood ratios and κ statistics for key elements of the medical history. Of particular importance to those working in primary care, statistically adjusted combinations of information from the medical history can be generated; furnishing clinicians with likelihood ratios of significant magnitudes. It is suggested that developing a more rational approach to the use of the medical history could lead to improvements in diagnostic efficiency and effectiveness, with benefits for individual patient care in addition to the overall NHS budget. When diagnosis is viewed as a processing pathway founded on a robust medical history, it becomes clear than in some situations investigations may become unnecessary and, in other circumstances, their impact will be enhanced.

Role of clinical context in residents’ physical examination diagnostic accuracy

“…In the diagnostic process, the clinical history often enables the development of hypotheses that are subsequently tested through physical examination, which, in turn, prompts further investigation when appropriate. 4,14 Studies of the relative contributions of these elements suggest that exploration of the clinical history alone leads to diagnosis in 56-83% of cases. [15][16][17] Studies investigating how the clinical history affects the subsequent interpretation of test data show variable results.…”

Missing or incomplete dental records: prevalence at Medunsa Oral Health Centre

“…This rather disappointing finding has important implications for patient safety and quality of care. It is generally accepted that past medical history is a powerful diagnostic technology 15 and an essential component of risk assessment for the likelihood of a patient experiencing a medical emergency. 16 A patient's medical history increases the dentist's awareness of diseases and medication which might interfere with the patient's dental treatment.…”

A case of Hamman's Sign: Value of auscultation

“…Ideally, laboratory tests and radiography should be tools used to confirm a diagnosis that is suspected on the basis of a complete history and physical examination [5]. Over the past several decades however, there is an increasing reliance on technology and less use of the fundamentals of medicine practice such as physical exam skills [6].…”