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In message <[log in to unmask]>, Timothy J Coats (SURG) 7728 <[log in to unmask]> writes >Simon - Congratulations on a clear exposition of some difficult >concepts. We should stop teaching our students 'classic' >presentations and stop looking for 'magic bullet' tests. Probability >theory should be an important part of everyday undergraduate >teaching - even though realisation of the amount of chance invoved >in medicine may worry them! > >Tim. Coats > >> For departments with a high throughput, excessive cerebration about test results introduces delay for patients and often results in indecision from our inexperienced SHO's. What today's busy clinician needs is a simple yes/no answer with minimum fuss and maximum speed and an absent margin for error. Clearly, this is not always achievable in every case. Certainly not with D-Dimers. This over-reliance on blood tests at vast expense to the NHS and A/E trolley time diminishes our standing as clinicians. What you do not want is a checklist based system where there are twenty items to check for each of up to twenty differential diagnoses, followed by waiting for the results of multiple tests. I think you will be hard pushed to beat old fashioned clinical judgement. -- Stephen Hughes %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%