Clinical testing in general practice. What is the evidence?
BACKGROUND
Evidence based medicine (EBM) is a term being used widely in reference to diagnostic tests and treatments. In EBM a test or a treatment is only utilised when there is solid evidence that the likelihood of benefit to the patient outweighs the risk of harm. However, EBM is rarely considered in the clinical aspects of medicine: history taking and examination. In looking for clinical signs doctors need to consider the accuracy of those signs and the implications that false negative or false positive results will have for their patient.


OBJECTIVE
The issues of sensitivity and specificity of clinical medicine are explored via the example of dementia testing in general practice.


CONCLUSIONS
The article demonstrates that although two commonly used screening tests for dementia have a high sensitivity (75%) and specificity (70%), there is little benefit in the routine use of these assessments for screening in general practice. Clues from appropriate history taking may be of greater diagnostic use.
Darzins
P
P
National Ageing Research Institute, University of Melbourne.
LoGiudice
D
D
D003704:Dementia / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D006801:Humans; D007361:Intelligence Tests; D008403:Mass Screening; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity