title: The influence of experience and specialisation on the reliability of a common clinical sign.
abstract: OBJECTIVE
  To explore the influence of experience and specialisation on clinical judgement by comparing accuracy in diagnosing anaemia between a consultant general surgeon, a consultant ophthalmologist and their registrars.
  
  
  METHODS
  Conjunctival inspection of 101 patients, subsequent correlation with haemoglobin concentration.
  
  
  METHODS
  Number of correct and incorrect diagnoses of anaemia.
  
  
  RESULTS
  54 patients were anaemic and 47 were not. Overall accuracy in diagnosing anaemia ranged from 0.61-0.69, sensitivity 0.52-0.65 and specificity 0.62-0.83. Agreements between pairs of examiners were 0.68-0.81, with kappa values of 0.36-0.60 when adjusted for chance agreement.
  
  
  CONCLUSIONS
  Neither experience nor specialisation significantly influenced our ability to diagnose anaemia, based on conjunctival inspection. Without critical analysis of clinical signs, we are unaware of their diagnostic limitations.
authors.affiliation: Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland.
authors.forename: D E
authors.initials: DE
authors.lastname: Wallace
authors.forename: G T
authors.initials: GT
authors.lastname: McGreal
authors.forename: G
authors.initials: G
authors.lastname: O'Toole
authors.forename: P
authors.initials: P
authors.lastname: Holloway
authors.forename: M
authors.initials: M
authors.lastname: Wallace
authors.forename: E W
authors.initials: EW
authors.lastname: McDermott
authors.forename: J
authors.initials: J
authors.lastname: Blake
mesh_terms: D000740:Anemia / Q000150:complications / Q000175:diagnosis*; D002983:Clinical Competence; D003229:Conjunctival Diseases / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D013502:General Surgery; D006801:Humans; D007494:Ireland; D008297:Male; D008505:Medical Staff, Hospital; D015588:Observer Variation; D009885:Ophthalmology; D010167:Pallor / Q000175:diagnosis* / Q000209:etiology; D010808:Physical Examination / Q000592:standards