Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World
Authors: Jeremy L. Warner
Journal: Annals of Internal Medicine (2009)

Letters3 February 2009Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary WorldJeremy L. Warner, MDJeremy L. Warner, MDFrom University of California, San Francisco, San Francisco, CA 94143.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-3-200902030-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Vickers and colleagues (1) discuss an interesting premise in their article: Physicians should consider moving away from the practice of diagnosis and toward the incorporation of risk stratification in their day-to-day practice. This raises several practical issues. The first is that the diagnoses that were discussed are all special cases in which the diagnosis had been defined by test results. Although many common diagnoses may fit into this category, many others can be suggested but not proven definitively by routine tests (pneumonia and pulmonary embolism are 2 that quickly come to mind). In these cases, diagnosis reflects ...References1. Vickers AJ, Basch E, Kattan MW. Against diagnosis. Ann Intern Med. 2008;149:200-3. [PMID: 18678847] LinkGoogle Scholar2. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837-47. [PMID: 9603539] CrossrefMedlineGoogle Scholar3. The Medical Algorithms Project. Accessed at www.medal.org on 11 December 2008. Google Scholar4. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29. [PMID: 3928249] CrossrefMedlineGoogle Scholar5. Windish DM, Huot SJ, Green ML. Medicine residents' understanding of the biostatistics and results in the medical literature. JAMA. 2007;298:1010-22. [PMID: 17785646] CrossrefMedlineGoogle Scholar6. Cuite CL, Weinstein ND, Emmons K, Colditz G. A test of numeric formats for communicating risk probabilities. Med Decis Making. 2008;28:377-84. [PMID: 18480036] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, CA 94143.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAgainst Diagnosis Andrew J. Vickers , Ethan Basch , and Michael W. Kattan Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World Benjamin Djulbegovic Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World Gregory Patrick Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World Robert A. Swerlick Risk Prediction Versus Diagnosis: Preserving Clinical Nuance in a Binary World Andrew J. Vickers , Ethan Basch , and Michael Kattan Metrics 3 February 2009Volume 150, Issue 3Page: 222KeywordsAlgorithmsBiostatisticsConflicts of interestDiagnostic medicineInformation technologyMedical educationPneumoniaPulmonary embolism ePublished: 3 February 2009 Issue Published: 3 February 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...