PERSPECTIVES
Testing our understanding of tests
Centre for Reviews and Dissemination, University of York, UK
Correspondence to:
Dr Bob Phillips, Centre for Reviews and Dissemination, University of York YO10 5DD, UK; bob.phillips@doctors.org.uk
Accepted 11 September 2008
| The first 150 words of the full text of this article appear below. |
Doctors have a prime role as diagnosticians and are encouraged to practise evidence based medicine (EBM). The classic Bayesian formulation of evidence based diagnostic testing1 relies on the estimation of a pretest probability, modified by the probabilistic estimate of test accuracy to produce a post-test probability. If this is high enough to cross a "treatment threshold", then therapy is commenced. Alternatively, if it is low enough, then one disregards the possibility of the diagnosis.
This probability modifying philosophy of diagnosis isn’t the only approach currently practiced in medicine. Other diagnostic traditions exist such as the "anatomical" (the neurologist asking, "What level is the spinal cord lesion at?"), the "criterion based" ("Do they score enough for Kawasaki disease?") and the "categorical" (a histopathologist asking, "Do those cells in that pattern looks like graft rejection?") and are useful at other times and in other ways.2 But, when you try to break things
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