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December 19, 1977

Chess and Combat: The Algorithm in Medicine

Author Affiliations

Scripps Clinic & Research Foundation La Jolla, Calif

JAMA. 1977;238(25):2721. doi:10.1001/jama.1977.03280260051019

From their inception with the Cabot cases (now published as clinicopathologic cases from Massachusetts General Hospital in the New England Journal of Medicine), physicians have learned from clinicopathologic cases (1) how mistaken a clinical diagnosis can be and (2) that the pathologist has the last word. The calm of the morgue is far different from the hurly-burly of the clinic, and clinicians need not feel the same reverence for the pathologists' judgments when confrontation occurs in the clinical laboratory.

This issue of The Journal (p 2709) offers an algorithm for the diagnosis of anemia and an example of its application to determine if the laboratory was properly or improperly used. It is a simplistic schema that provides, on the basis of hemoglobin concentration and a computation of average RBC size, a recipe for the workup of anemia. On their procrustean bed, the authors placed charts of 258 consecutive cases of