[EXTERNAL][IMPROVEDX] Balancing misclassification costs & numerators\denominators

Bimal Jain bjain at PARTNERS.ORG
Wed Dec 18 14:06:47 UTC 2013

I find the discussion about role of probabilities in diagnosis, for example, of acute cardiac ischemia fascinating. I believe, probabilities have little or no role in clinical diagnosis, as our goal is to diagnose a disease correctly in a particular, individual patient. In such a patient, a probability, whether high or low is not evidence for presence or absence of disease. A probability only informs us about distribution of disease in a series of patients but tells us nothing about disease in a particular patient. A clinical presentation should be employed, I suggest, only to suspect a disease, regardless of whether the prior probability is low or high. The suspected disease should then be evaluated by tests which yield highly informative results. For example, acute Q wave and ST elevation changes in EkG alone should lead to definitive diagnosis of acute myocardial infarction, regardless of whether its prior probability is high or low. I believe, basing clinical diagnosis on probabilities is a major source of diagnostic error which can be avoided by recognising their non-role in diagnosis.

Bimal P Jain, MD
Pulmonary-Critical Care
North Shore Medical Center (Union)
Lynn, MA 01904

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