I think Nick has just coined a new term for a medical problem which is not just applicable to fractures of the scaphoid. He mentions a low threshold MRI system for detecting fractures but which misses those fractures without clinical symptoms. There are other examples where technology is ahead of clinical examination, and maybe we have to re-think our training as doctors. Most clinical signs are hallowed by time but were developed before the technology became available to produce hard evidence. Abraham Colles never saw an Xray, but we still use his terminology and signs; fractured neck of femur is only diagnosed on xray as clinical signs alone are unreliable. Now that CT and MRI are available we have to use them so that deciding who does and doesn't get scanned for say headache becomes a much more difficult clinical problem as we can all remember patients who had a scan for the "wrong indication" producing a positive finding. That then colours your decision making for the rest of your time in medicine.
What I'm really rambling on about (quiet morning at the office) is that no system is perfect, you will fail some of the time so keep smiling and pay your defence fees. There are "sacphoids" all around.
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