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November 29, 1976

Diagnosis by Deduction: Reprise

JAMA. 1976;236(22):2534-2535. doi:10.1001/jama.1976.03270230056038

Two errors marred an earlier editorial (235:1884, 1976) about the importance of deductive reasoning as a means to accurate diagnosis. The first error occurred in the note about constrictive pericarditis where the term "small, quiet heart" appeared. A discerning reader promptly called attention to the fact that a roentgenogram often shows an enlarged cardiac silhouette in cases of cardiac compression. (Thank goodness for readers who write letters that keep editors humble!) The second was an error of omission. The editorial failed to emphasize that rapidly advancing therapeutic methods have increased the importance of diagnosis by deduction. For example, during medicine's present era, early diagnosis of bacterial endocarditis has changed from an interesting, though futile, intellectual exercise to a question of life or death.

In recognition of the latter point, Spencer,1 in his presidential address to the 1976 meeting of the International Cardiovascular Society, chose the topic "Deductive Reasoning in