Ehud Zamir ezamir at UNIMELB.EDU.AU
Thu Sep 5 03:05:55 UTC 2013

If I see a patient with a diagnosis  X which has been made elsewhere, and that diagnosis happens to be incorrect, and if the patient actually has problem Y (unequivocally, when worked up properly) then a study showing that I am more likely to conclude Y than X if I see the patient before reading the referral letter, the point is proven. For instance, X can be an exacerbation of COPD and Y can be a PE. The latter can usually be proven, and once proven, the PE is the "gold standard". To prove the point one would chose situations where it is easy to accept a gold standard, unequivocal diagnosis.
The author does not advocate diagnosing "without history" but only diagnosing independently first. He says it at the start of the paper: "The history helps. Interpreting images while unaware of the patient’s problem is foolish. If you aren’t sure what the question is, it’s tough to give the right answer."

From: Swerlick, Robert A [rswerli at]
Sent: Thursday, 5 September 2013 12:28 PM
To: Society to Improve Diagnosis in Medicine; Ehud Zamir
Subject: Re: [IMPROVEDX] Article

I am still skeptical. These studies show that results using a subjective test obtained without history are different from those obtained with a history. But where is the gold standard? Which one is right?

Robert A. Swerlick, MD

On Sep 4, 2013, at 6:54 PM, "Ehud Zamir" <ezamir at UNIMELB.EDU.AU<mailto:ezamir at UNIMELB.EDU.AU>> wrote:

Following our discussion here a  about the merits of forming an unbiased opinion prior to reading previous information, I found a paper which talks exactly about that, by N. Thorne Griscom, MD from the Children's Hospital in Boston: A Suggestion: Look at the Images First, Before You Read The History. Radiology, April 2002, 9-10. It is a short but well written paper. It's free online, on

I believe it applies to any diagnostic situation where a patient is referred by another doctor with assumptions and diagnoses already made by someone else.

Ehud Zamir



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