Who makes the diagnosis? The role of clinical skills and diagnostic test results

J Eval Clin Pract. 2007 Jun;13(3):321-5. doi: 10.1111/j.1365-2753.2006.00691.x.


Rationale, aims and objectives: Advances in medicine have led to a multitude of diagnostic tests. The contribution of the clinical skills of the general internist in the context of all these advances is unknown. Our objective was to assess the relative contributions of clinical skills and diagnostic test results in arriving at a final diagnosis.

Methods: Records were retrospectively reviewed from 248 consecutive patients admitted to a general internal medicine hospital service during a 3-month period in 2000. All diagnostic evaluations that yielded the final diagnosis were recorded along with the date and time they were performed. Diagnostic credit was given to the evaluation that yielded the diagnosis at the earliest point in time.

Results: All cases had a firm diagnosis by 3 months after hospitalization. Of the 248 patients, 246 received a final diagnosis during hospitalization. The diagnoses were made by use of the clinical judgement of the general internist in 50.4% of the cases, a radiologic study in 31.7%, a blood test or culture result in 9.4%, biopsy findings in 3.3% and various other diagnostic studies (endoscopy, echocardiography, electromyography and electroencephalography) in 5.2%. Clinicians provided the correct diagnosis significantly more often than radiologic studies (P = 0.0015), which was the next most useful type of diagnostic evaluation.

Conclusion: Although technology has become increasingly available in clinical practice, clinical expertise and skills are still important factors with respect to making correct, timely diagnoses in hospitalized patients.

MeSH terms

  • Clinical Competence*
  • Diagnosis, Differential*
  • Diagnostic Tests, Routine*
  • Humans
  • Medical Audit
  • Retrospective Studies
  • United States