RT Journal Article
SR Electronic
T1 The medical history as a diagnostic technology
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP 273
OP 276
DO 10.3399/bjgp08X279779
VO 58
IS 549
A1 Nick Summerton
YR 2008
UL http://bjgp.org/content/58/549/273.abstract
AB 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.