Clinical paradigms revisited

Kenneth Wong
Med J Aust 2006; 185 (11): . || doi: 10.5694/j.1326-5377.2006.tb00749.x
Published online: 4 December 2006

To the Editor: Schattner’s call to resurrect history-taking and examination as the dominant means of clinical diagnosis1 is analogous to advocating a return to cave-dwelling and spear-hunting for food in the era of houses and supermarkets. Even the most ardent supporters of history and examination would acknowledge that they can be grossly inaccurate, in possibly up to 30% of cases.1 Clearly, without using further diagnostic tools, there would be an unacceptably high rate of missed, incorrect or delayed diagnoses with associated morbidity, mortality and financial costs to the patient, hospital and community. Therefore, there is an urgent need to challenge the “politically correct” and entrenched paradigm of history and examination as the initial approach to diagnosis and management.

  • Gosford Hospital, Gosford, NSW.


  • 1. Schattner A. Clinical paradigms revisited. Med J Aust 2006; 185: 273-275. <MJA full text>
  • 2. Federle MP. CT of the acute (emergency) abdomen. Eur Radiol 2005; 15 Suppl 4: D100-D104.
  • 3. Salem TA, Molloy RG, O’Dwyer PJ. Prospective study on the role of the CT scan in patients with an acute abdomen. Colorectal Dis 2005; 7: 460-466.


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