Do clinicians decide relying primarily on Bayesian principles or on Gestalt perception

I have read with interest the article by Cervellin et al. [1] and the editorial by Donatella Lippi [2]. While I agree in part with both, I have some strong reservations about both that I will try to articulate. First of all, no diagnosis is made by statistics. If the responsible physician does not think of the entity, there is no possible way to embark upon any form of workup to search for the proof of the presence of the disease. Moreover, in Emergency Medicine, the underlying diagnosis is often less important to the initial management of the patient than the attempt to restore a more normal physiology to prevent an untimely death; there being but a small number of ways that finally lead to death, but an almost infinite number of diseases that can place one on one of those pathways. Secondly, while statistics are a vital part of the evaluation of the testing of a research hypothesis, they cannot play a great role in the clinical assessment of a patient, no matter how well derived are the various scores of prognostication and probability for the presence of the disease. If one cannot make a clinical assessment, it is impossible to form an assessment of the prior probability of the disease being considered, thus invalidating all of the rules for the use of various diagnostic tests. Thirdly, the increasing number of pleas for the education and formation of a more humane physician is not an either/or matter. A great deal of the formulation of initial impressions and management must come from good clinical instinct, as well as good clinical experience. The great physicians are the ones who understand people as well as disease. To Dr. Lippi, I could not agree more that reading non medical literature is of great help in the production of an educated person whether or not that person is a physician. I have also tried to communicate this to my students, since I think that reading non science and non medical literature is an excellent way to understand not only the psychology of the patient, but also the current perceptions of ones society and culture. Yet, if I have to choose for their perusal something medical or something non medical, I would suggest starting with science. If one does not know medicine, it is impossible to intuit anything about how the body works or fails to work. Moreover, I would be careful about recommending any particular piece of literature. When one has personally read and loved a work, it is fun to share the enthusiasm and pleasure, but I think you could know the Iliad or the Inferno by heart in the original Greek and Italian, and never learn how to recognize a pulmonary embolus. I agree that one of the things we must become better at to be great physicians is to convey to our patients that we care, and that we are trying. Ms. Allende blames the physician specialist because her daughter has an incurable congenital disease, from which she is going to die. What she wanted was a saint to produce a miracle, and could not hear the ‘‘unfeeling specialist’’ who was trying to communicate the inevitable endpoint to her. Moreover, there are many times that we must put empathy away, and do things to patients that we would This comment refers to the article available at doi:10.1007/s11739014-1049-8.