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

Bob Latino blatino at RELIABILITY.COM
Wed Dec 18 19:11:32 UTC 2013


Does a higher reliance on probabilities to make an individual diagnosis increase the risk of confirmation bias? 

Does this heavier reliance on the probabilities cause us not to explore potential uniqueness's in an individual's case?

Robert (Bob) J. Latino
CEO
Reliability Center, Inc., P.O. Box 1421, Hopewell, VA  23860
(O) 804.458.0645  (F) 804.452.2119
blatino at reliability.com l http://www.reliability.com 

-----Original Message-----
From: Bimal Jain [mailto:bjain at PARTNERS.ORG] 
Sent: Wednesday, December 18, 2013 9:07 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] [EXTERNAL][IMPROVEDX] Balancing misclassification costs & numerators\denominators

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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