title: An analysis of paediatric diagnostic decision-making: how should students be taught?
abstract: This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out-patient Department of the Central Middlesex Hospital, London, by means of a questionnaire-based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety-one per cent of cases were diagnosed without recourse to investigations. Forty-two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history-taking skills and the subsequent purpose of examination.
authors.affiliation: Department of Paediatrics, Central Middlesex Hospital, London, UK.
authors.forename: L S
authors.initials: LS
authors.lastname: Miall
authors.forename: H
authors.initials: H
authors.lastname: Davies
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D003933:Diagnosis; D004504:Education, Medical, Undergraduate; D008487:Medical History Taking; D010372:Pediatrics / Q000193:education*; D013663:Teaching / Q000379:methods*