Who makes the diagnosis? The role of clinical skills and diagnostic test results

Dietlind L. Wahner-Roedler, Swarna S. Chaliki, Brent A Bauer, John B. Bundrick, Larry R. Bergstrom, Mark C. Lee, Stephen S. Cha, Peter L. Elkin

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Rationale, aims and objectives: Advances in medicine have led to a multitude of diagnostic tests. The contribution of the clinical skills of the general internist in the context of all these advances is unknown. Our objective was to assess the relative contributions of clinical skills and diagnostic test results in arriving at a final diagnosis. Methods: Records were retrospectively reviewed from 248 consecutive patients admitted to a general internal medicine hospital service during a 3-month period in 2000. All diagnostic evaluations that yielded the final diagnosis were recorded along with the date and time they were performed. Diagnostic credit was given to the evaluation that yielded the diagnosis at the earliest point in time. Results: All cases had a firm diagnosis by 3 months after hospitalization. Of the 248 patients, 246 received a final diagnosis during hospitalization. The diagnoses were made by use of the clinical judgement of the general internist in 50.4% of the cases, a radiologic study in 31.7%, a blood test or culture result in 9.4%, biopsy findings in 3.3% and various other diagnostic studies (endoscopy, echocardiography, electromyography and electroencephalography) in 5.2%. Clinicians provided the correct diagnosis significantly more often than radiologic studies (P = 0.0015), which was the next most useful type of diagnostic evaluation. Conclusion: Although technology has become increasingly available in clinical practice, clinical expertise and skills are still important factors with respect to making correct, timely diagnoses in hospitalized patients.

Original languageEnglish (US)
Pages (from-to)321-325
Number of pages5
JournalJournal of Evaluation in Clinical Practice
Volume13
Issue number3
DOIs
StatePublished - Jun 2007

Fingerprint

Clinical Competence
Routine Diagnostic Tests
Hospitalization
Electromyography
Internal Medicine
Endoscopy
Echocardiography
Electroencephalography
Medicine
Technology
Biopsy

Keywords

  • Clinical skills
  • Diagnosis
  • Diagnostic techniques and procedures

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Information Management
  • Nursing(all)

Cite this

Wahner-Roedler, D. L., Chaliki, S. S., Bauer, B. A., Bundrick, J. B., Bergstrom, L. R., Lee, M. C., ... Elkin, P. L. (2007). Who makes the diagnosis? The role of clinical skills and diagnostic test results. Journal of Evaluation in Clinical Practice, 13(3), 321-325. https://doi.org/10.1111/j.1365-2753.2006.00691.x

Who makes the diagnosis? The role of clinical skills and diagnostic test results. / Wahner-Roedler, Dietlind L.; Chaliki, Swarna S.; Bauer, Brent A; Bundrick, John B.; Bergstrom, Larry R.; Lee, Mark C.; Cha, Stephen S.; Elkin, Peter L.

In: Journal of Evaluation in Clinical Practice, Vol. 13, No. 3, 06.2007, p. 321-325.

Research output: Contribution to journalArticle

Wahner-Roedler, DL, Chaliki, SS, Bauer, BA, Bundrick, JB, Bergstrom, LR, Lee, MC, Cha, SS & Elkin, PL 2007, 'Who makes the diagnosis? The role of clinical skills and diagnostic test results', Journal of Evaluation in Clinical Practice, vol. 13, no. 3, pp. 321-325. https://doi.org/10.1111/j.1365-2753.2006.00691.x
Wahner-Roedler, Dietlind L. ; Chaliki, Swarna S. ; Bauer, Brent A ; Bundrick, John B. ; Bergstrom, Larry R. ; Lee, Mark C. ; Cha, Stephen S. ; Elkin, Peter L. / Who makes the diagnosis? The role of clinical skills and diagnostic test results. In: Journal of Evaluation in Clinical Practice. 2007 ; Vol. 13, No. 3. pp. 321-325.
@article{a57150322e9b41d1849183fe277d81b7,
title = "Who makes the diagnosis? The role of clinical skills and diagnostic test results",
abstract = "Rationale, aims and objectives: Advances in medicine have led to a multitude of diagnostic tests. The contribution of the clinical skills of the general internist in the context of all these advances is unknown. Our objective was to assess the relative contributions of clinical skills and diagnostic test results in arriving at a final diagnosis. Methods: Records were retrospectively reviewed from 248 consecutive patients admitted to a general internal medicine hospital service during a 3-month period in 2000. All diagnostic evaluations that yielded the final diagnosis were recorded along with the date and time they were performed. Diagnostic credit was given to the evaluation that yielded the diagnosis at the earliest point in time. Results: All cases had a firm diagnosis by 3 months after hospitalization. Of the 248 patients, 246 received a final diagnosis during hospitalization. The diagnoses were made by use of the clinical judgement of the general internist in 50.4{\%} of the cases, a radiologic study in 31.7{\%}, a blood test or culture result in 9.4{\%}, biopsy findings in 3.3{\%} and various other diagnostic studies (endoscopy, echocardiography, electromyography and electroencephalography) in 5.2{\%}. Clinicians provided the correct diagnosis significantly more often than radiologic studies (P = 0.0015), which was the next most useful type of diagnostic evaluation. Conclusion: Although technology has become increasingly available in clinical practice, clinical expertise and skills are still important factors with respect to making correct, timely diagnoses in hospitalized patients.",
keywords = "Clinical skills, Diagnosis, Diagnostic techniques and procedures",
author = "Wahner-Roedler, {Dietlind L.} and Chaliki, {Swarna S.} and Bauer, {Brent A} and Bundrick, {John B.} and Bergstrom, {Larry R.} and Lee, {Mark C.} and Cha, {Stephen S.} and Elkin, {Peter L.}",
year = "2007",
month = "6",
doi = "10.1111/j.1365-2753.2006.00691.x",
language = "English (US)",
volume = "13",
pages = "321--325",
journal = "Journal of Evaluation in Clinical Practice",
issn = "1356-1294",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Who makes the diagnosis? The role of clinical skills and diagnostic test results

AU - Wahner-Roedler, Dietlind L.

AU - Chaliki, Swarna S.

AU - Bauer, Brent A

AU - Bundrick, John B.

AU - Bergstrom, Larry R.

AU - Lee, Mark C.

AU - Cha, Stephen S.

AU - Elkin, Peter L.

PY - 2007/6

Y1 - 2007/6

N2 - Rationale, aims and objectives: Advances in medicine have led to a multitude of diagnostic tests. The contribution of the clinical skills of the general internist in the context of all these advances is unknown. Our objective was to assess the relative contributions of clinical skills and diagnostic test results in arriving at a final diagnosis. Methods: Records were retrospectively reviewed from 248 consecutive patients admitted to a general internal medicine hospital service during a 3-month period in 2000. All diagnostic evaluations that yielded the final diagnosis were recorded along with the date and time they were performed. Diagnostic credit was given to the evaluation that yielded the diagnosis at the earliest point in time. Results: All cases had a firm diagnosis by 3 months after hospitalization. Of the 248 patients, 246 received a final diagnosis during hospitalization. The diagnoses were made by use of the clinical judgement of the general internist in 50.4% of the cases, a radiologic study in 31.7%, a blood test or culture result in 9.4%, biopsy findings in 3.3% and various other diagnostic studies (endoscopy, echocardiography, electromyography and electroencephalography) in 5.2%. Clinicians provided the correct diagnosis significantly more often than radiologic studies (P = 0.0015), which was the next most useful type of diagnostic evaluation. Conclusion: Although technology has become increasingly available in clinical practice, clinical expertise and skills are still important factors with respect to making correct, timely diagnoses in hospitalized patients.

AB - Rationale, aims and objectives: Advances in medicine have led to a multitude of diagnostic tests. The contribution of the clinical skills of the general internist in the context of all these advances is unknown. Our objective was to assess the relative contributions of clinical skills and diagnostic test results in arriving at a final diagnosis. Methods: Records were retrospectively reviewed from 248 consecutive patients admitted to a general internal medicine hospital service during a 3-month period in 2000. All diagnostic evaluations that yielded the final diagnosis were recorded along with the date and time they were performed. Diagnostic credit was given to the evaluation that yielded the diagnosis at the earliest point in time. Results: All cases had a firm diagnosis by 3 months after hospitalization. Of the 248 patients, 246 received a final diagnosis during hospitalization. The diagnoses were made by use of the clinical judgement of the general internist in 50.4% of the cases, a radiologic study in 31.7%, a blood test or culture result in 9.4%, biopsy findings in 3.3% and various other diagnostic studies (endoscopy, echocardiography, electromyography and electroencephalography) in 5.2%. Clinicians provided the correct diagnosis significantly more often than radiologic studies (P = 0.0015), which was the next most useful type of diagnostic evaluation. Conclusion: Although technology has become increasingly available in clinical practice, clinical expertise and skills are still important factors with respect to making correct, timely diagnoses in hospitalized patients.

KW - Clinical skills

KW - Diagnosis

KW - Diagnostic techniques and procedures

UR - http://www.scopus.com/inward/record.url?scp=34249000988&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34249000988&partnerID=8YFLogxK

U2 - 10.1111/j.1365-2753.2006.00691.x

DO - 10.1111/j.1365-2753.2006.00691.x

M3 - Article

C2 - 17518794

AN - SCOPUS:34249000988

VL - 13

SP - 321

EP - 325

JO - Journal of Evaluation in Clinical Practice

JF - Journal of Evaluation in Clinical Practice

SN - 1356-1294

IS - 3

ER -