A Fraction of the Picture

The prior probabilities of disease profoundly influence the decisions of the practitioner in making diagnostic decisions. Generalists look at subspecialists and are tempted to conclude that they are always seeking zebras. Subspecialists are tempted to look back at generalists and conclude that they are always missing things. Our denominator populations are different. Our error rates are not necessarily different…

Rather than pursue medical internecine warfare, consider that we in medicine as a whole have been turning to the entire population and telling it how it ought to function for health. The estimates of patient self-selection prior to seeking medical attention is probably an underestimation of the self-selection that takes place before any of us in medicine see the patient. Other studies estimate that physicians see patients in only 6% of all episodes of illness. Not only are we prone to be mechanistically disease-oriented, we see only a fraction of the whole picture!


Excerpts from Physician and Pastor: Co-Laborers