A number of participants have queried why for some Cases for Comment, those
people who offered correct advice (given the eventual outcome of the Case)
received less marks than those who suggested inappropriate further
investigations. This has been apparent in a few Cases, most notably Avril
Owen's Case 46, where those who suggested pregnancy received less marks
than those who suggested investigation of an androgen-secreting tumour.
First, you have to remember that our assessors are scoring 'blind' -
without knowing any outcome; and they are only human like the rest of us.
And even the mean best guess of independent specialists does not always
lead to the truth.
Second, the marks are being given based upon what the assessors feel is
reasonable at the time the Case is seen. What is the most reasonable at the
time is not necessarily the eventual outcome of a Case, particularly a more
unusual Case. Avril's Case was unusual, in that most of us are unaware that
pregnancy can give rise to elevated maternal androgens (I am told that this
is more so for a male foetus); and most of us would not believe A. that
three experienced clinicians could miss a second trimester pregnancy, and
B. that a urine pregnancy test at around ten weeks pregnancy would turn out
negative (was the sample from the right patient, I wonder).
So please remember that scoring Cases for Comment is meant as an
independent guide to the most appropriate comment or action given a set of
abnormalities, not as the absolute truth relating to an individual Case. Li
Ping and I will be studying all of the marking related to the first twenty
scored Cases early in the new year; and hopefully we will be able to
publish our findings from this in mid-1999.
With best wishes
Gordon Challand
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