Roshan M, Rao A P
Fr. Muller's Medical College, Kankanady, Mangalore-575 002.
J Assoc Physicians India. 2000 Aug;48(8):771-5.
Here we report an attempt to quantitate the relative contributions of the history, physical examination and investigations in making medical diagnosis. In this prospective study of 100 patients, with new or previously undiagnosed conditions, we listed their differential diagnosis with confidence score; after the history, after physical examination and after the investigations. In two patients no definite final diagnoses could be arrived even after extensive investigation--these two cases were excluded from the study. In seventy seven patients (78.58%) patients, the history led to diagnosis. The physical examination led to diagnosis in eight patients (8.17%); and investigations led to diagnosis in 13 patients (13.27%). The confidence in correct diagnosis increased from 6.36 on a scale of one to ten after the history to 7.57 after physical examination and 9.84 after investigations--implying that history, physical examination and investigation have their own limitation at each stage and an integrative approach is needed in making a medical diagnosis with more emphasis on history.
在此，我们报告一项旨在量化病史、体格检查及各项检查在医学诊断中相对贡献的尝试。在这项针对100例患有新发或既往未确诊疾病患者的前瞻性研究中，我们列出了他们的鉴别诊断及信心评分；分别是在采集病史后、体格检查后及各项检查后。有两名患者即便经过广泛检查仍无法得出明确的最终诊断——这两例被排除在研究之外。在77例患者（78.58%）中，病史导向了诊断。体格检查导向诊断的有8例患者（8.17%）；各项检查导向诊断的有13例患者（13.27%）。对正确诊断的信心评分从采集病史后的6.36（满分10分）升至体格检查后的7.57以及各项检查后的9.84——这意味着病史、体格检查及各项检查在每个阶段都有其自身局限性，在进行医学诊断时需要一种综合方法，且应更着重于病史。
