Clinical paradigms revisited

To the Editor: Schattner’s call to resurrect history-taking and examination as the dominant means of clinical diagnosis1 is analogous to advocating a return to cave-dwelling and spear-hunting for food in the era of houses and supermarkets. Even the most ardent supporters of history and examination would acknowledge that they can be grossly inaccurate, in possibly up to 30% of cases.1 Clearly, without using further diagnostic tools, there would be an unacceptably high rate of missed, incorrect or delayed diagnoses with associated morbidity, mortality and financial costs to the patient, hospital and community. Therefore, there is an urgent need to challenge the “politically correct” and entrenched paradigm of history and examination as the initial approach to diagnosis and management.