Rational use of diagnostic tests for individual patients is a core skill required of every GP. Despite the widespread acknowledgement that competency in the understanding and application of diagnostic tests is important, medical curricula at undergraduate and postgraduate level do not place substantial emphasis on development and assessment of quantitative diagnostic knowledge and skills, certainly when compared to assessment of competency in therapeutics. This has led some commentators to call for revision in assessment of clinical competencies, so that a greater emphasis is placed on diagnostic competency in postgraduate medical training.1
There are particular diagnostic challenges for GPs in primary care: the prior or pre-test probability of disease is lower in community settings, and availability of common diagnostic tests more limited when compared to secondary care.2 GPs generally deal with far greater diagnostic uncertainty than their hospital-based colleagues, this being part of the key gatekeeping role of primary care.
For these reasons the paper by Fuat et al in this month's edition of the Journal, that reports on the diagnostic accuracy of B-type natriuretic peptide (BNP), N-terminal B type natriuretic peptide (NT proBNP) as well as electrocardiogram (ECG) in the diagnosis of left ventricular systolic dysfunction (LVSD), is welcome. Their study shows that application of any of these three tests to patients with an intermediate prior probability of LVSD (estimated in their study population to be 38%) is helpful in ‘ruling out’ LVSD in a primary care …