title: The clinical diagnostic reasoning process determining the use of endoscopy in diagnosing peptic ulcer disease.
abstract: OBJECTIVE
  To evaluate the clinical diagnostic reasoning process as a tool to decrease the number of unnecessary endoscopies for diagnosing peptic ulcer disease. tudy
  
  
  METHODS
  Cross-sectional KAP study.
  
  
  METHODS
  Shifa College of Medicine, Islamabad, from April to August 2010.
  
  
  METHODS
  Two hundred doctors were assessed with three common clinical scenarios of low, intermediate and high pre-test probability for peptic ulcer disease using a questionnaire. The differences between the reference estimates and the respondents' estimates of pre-test and post test probability were used for assessing the ability of estimating the pretest probability and the post test probability of the disease. Doctors were also enquired about the cost-effectiveness and safety of endoscopy. Consecutive sampling technique was used and the data was analyzed using SPSS version 16.
  
  
  RESULTS
  In the low pre-test probability settings, overestimation of the disease probability suggested the doctors' inability to rule out the disease. The post test probabilities were similarly overestimated. In intermediate pre-test probability settings, both over and under estimation of probabilities were noticed. In high pre-test probability setting, there was no significant difference in the reference and the responders' intuitive estimates of post test probability. Doctors were more likely to consider ordering the test as the disease probability increased. Most respondents were of the opinion that endoscopy is not a cost-effective procedure and may be associated with a potential harm.
  
  
  CONCLUSIONS
  Improvement is needed in doctors' diagnostic ability by more emphasis on clinical decision-making and application of bayesian probabilistic thinking to real clinical situations.
authors.affiliation: Department of Medicine, Shifa College of Medicine, Islamabad. doctornaheed@live.com
authors.forename: Naheed
authors.initials: N
authors.lastname: Gul
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Quadri
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D002983:Clinical Competence; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010154:Pakistan; D010437:Peptic Ulcer / Q000175:diagnosis*; D011336:Probability; D011340:Problem Solving; D011795:Surveys and Questionnaires; D013850:Thinking