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JAMA 100 Years Ago
July 6, 2005


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2005;294(1):112. doi:10.1001/jama.294.1.112-b

One of the temptations which come to the clinician of even moderate experience is the tendency to make diagnoses on sight, the so-called “snapshot” diagnosis. The innate desire to play to the gallery which is present to some extent in most of us, as well as the wish to appear preternaturally brilliant in the eyes of the public or the student, is the cause of this temptation. Even the most conservative among us gets into the habit of making subconscious snapshots when he almost unconsciously sizes up a patient at his first visit. While such diagnoses are occasionally justified, they are, in the long run, severely to be condemned. Certain diseases are, in their well-marked forms, so characteristic that even the tyro can hardly fail to recognize them. A number might be mentioned, acromegaly, exophthalmic goiter, myxedema, and osteitis deformans among the rest. But it is in the fruste forms of just these diseases that diagnosis may be most difficult. The habit is one which, in the long run, leads to careless observation, and while it leads to a few brilliant diagnoses, causes many regrettable mistakes. The humorous side of the matter is well illustrated by a story recounted by Byrom Bramwell in a recent address.1 A physician who was very great on physiognomonic diagnosis in going through the wards one day directed the attention of his students to the teeth of a patient, saying that they were splendid examples of gouty teeth. The patient, seeing that the professor was so much interested, took the teeth out and handed them to him, asking if he would like to examine them more closely. A word to the wise is sufficient.

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