Cassandra and the Clinician: Are Clinical Prediction Rules Changing the Practice of Medicine?
Authors: Paul E. Epstein
Journal: Annals of Internal Medicine (1990)

Editorials1 November 1990Cassandra and the Clinician: Are Clinical Prediction Rules Changing the Practice of Medicine?Paul E. Epstein, MDPaul E. Epstein, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-113-9-646 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTechnologic advances in medicine have been both boon and burden to physicians, patients, and health care planners. In an era of explosive health care costs, a major challenge is to improve diagnostic accuracy while controlling expenditures. However, for the generations of physicians who were weaned on Osler's exhortation to "diagnose, diagnose, diagnose," the need to practice diagnostic restraint is a bitter pill indeed. Yet, in the 1990s, the final marginal increase in diagnostic accuracy comes at an extraordinarily high monetary cost. To budget our medical resources responsibly, we must be increasingly ingenious in approaching test utilization and increasingly analytic in...References1. HeckerlingTapeWigton PTR. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med. 1990;113:664-70. LinkGoogle Scholar2. WassonHaroldNeffGoldman JHRL. Clinical prediction rules, applications and methodological standards. N Engl J Med. 1985;313:793-9. CrossrefMedlineGoogle Scholar3. WalshBookheimJohnsonTompkins BWRR. Recognition of streptococcal pharyngitis in adults. Arch Intern Med. 1975;135:1493-7. CrossrefMedlineGoogle Scholar4. SingalHedgesRadack BJK. Decision rules and clinical prediction of pneumonia. Ann Emerg Med. 1989;18:13-20. CrossrefMedlineGoogle Scholar5. DiehrWoodBushyheadKruegerWolcottTompkins DRJLBR. Prediction of pneumonia in outpatients with acute cough. J Chronic Dis. 1984;37:215-25. CrossrefMedlineGoogle Scholar6. BrandFrazierKohlhepp DWW. A protocol for selecting patients with injured extremities who need x-rays. N Engl J Med. 1982;306:333-9. CrossrefMedlineGoogle Scholar7. DetskyRedelmeierAbrams ADH. What's wrong with decision analysis? Can the left brain influence the right? J Chronic Dis. 1987;40:831-6. CrossrefMedlineGoogle Scholar8. Feinstein A. The "chagrin factor" and qualitative decision analysis. Arch Intern Med. 1985;145:1257-9. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Graduate Hospital Philadelphia, PA 19146 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHealth Policy for Infection Control and Epidemiology in Critical CareThe Tools of Quality Improvement: CQI versus EpidemiologyRapid classification of positive blood culturesGuideline-based Consultation To Prevent Anticoagulant-related Bleeding A Randomized, Controlled Trial in a Teaching HospitalC. Seth Landefeld, Philip A. Anderson, MDUse of rapid serial sampling of creatine kinase MB for very early detection of myocardial infarction in patients with acute chest painOn Art and Science in MedicineInvestigations: how to get from guidelines to protocols.Blame is not the pointUse of ambulances in outpatient departments.Computer aided teaching packages.Computer aided teaching packagesComputer aided teaching packagesClinical Prediction RulesThomas D. Mendez, MD 1 November 1990Volume 113, Issue 9Page: 646-647KeywordsHealth carePatients ePublished: 1 December 2008 Issue Published: 1 November 1990 PDF downloadLoading ...