Sandler G
Br Med J. 1979 Jul 7;2(6181):21-4. doi: 10.1136/bmj.2.6181.21.
The relative importance of the history, examination, and routine and special investigations has been assessed in the diagnosis and management of 630 medical outpatients. The history was the most important factor in both diagnosis and management in cardiovascular, neurological, respiratory, urinary, and other miscellaneous problems, and decided 56% of all diagnoses and 46% of all management. Examination findings were of more limited value, accounting for only 17% of diagnostic and 17% of management decisions overall. Routine haematology and urine examinations were of minimal value, contributing to less than 1% of all diagnoses. Special investigations decided most of the diagnoses and management in alimentary and endocrine problems, but were less helpful in problems affecting all other systems. If a local survey in the Trent Region reflected the pattern of medical outpatient practice nationally, then pounds 1.25 million could be saved annually if routine investigation was discontinued on all patients whose problem had already been diagnosed on the basis of the history and the clinical examination.
对630名内科门诊患者进行诊断和管理时，已对病史、检查以及常规和特殊检查的相对重要性进行了评估。在心血管、神经、呼吸、泌尿及其他杂症问题的诊断和管理中，病史是最重要的因素，它决定了所有诊断的56%以及所有管理决策的46%。检查结果的价值较为有限，总体上仅占诊断决策的17%和管理决策的17%。常规血液学和尿液检查价值极小，对所有诊断的贡献不到1%。特殊检查决定了消化系统和内分泌系统问题的大部分诊断和管理，但在影响所有其他系统的问题上帮助较小。如果特伦特地区的一项局部调查反映了全国内科门诊的诊疗模式，那么对于那些根据病史和临床检查已确诊病情的患者，如果停止进行常规检查，每年可节省125万英镑。
