The necessary shift from diagnostic to prognostic research.
BACKGROUND
Do doctors really need to establish an etiological diagnosis each time a patient presents? Or might it often be more effective to treat simply on the basis of symptoms and signs alone, relying on research and on our experience of outcomes for patients who presented in similar ways in the past?


CONCLUSIONS
At a time of increase health care costs especially in pharmaceuticals and expensive diagnostic tests, this article uses examples from recent research to address this question. Our examples come from general practice, because that is where doctors frequently see patients presenting with a yet undifferentiated disease which is consequently difficult to diagnose. The examples include respiratory tract infections, low back pain and shoulder pain. Finally we discuss the 'something is wrong' feeling.


CONCLUSIONS
We conclude that, in addition to diagnostic research, a renewed focus on prognostic research is needed.
Dinant
Geert-Jan G J
GJ
Department of General Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands. geertjan.dinant@hag.unimaas.nl
Buntinx
Frank F
FF
Butler
Chris C C
CC
D035843:Biomedical Research / Q000639:trends*; D003954:Diagnostic Services / Q000706:statistics & numerical data*; D005194:Family Practice / Q000639:trends; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000175:diagnosis